Heinz Wolff, Emeritus Professor of Bioengineering
Prof Robert Macredie, Professor of Interactive Systems
Brunel University, Uxbridge, Middlesex UB8 3PH
Care4Care: Supporting Others, Providing for Yourself
Summary
For some time we have been lecturing and speaking to likely organisations about a scheme which, were it to be successfully introduced, would have a major impact on the comfort care and support (C&S, in future) of frail elderly people. Care4Care is based on our view that, as the result of the challenges posed by the credit crunch, competition from the emerging economies, and the ageing population, the government will have to concentrate on funding the NHS and will largely have to withdraw from the C&S of frail, old people. In response, we believe that the community will have to assume this responsibility.
So what is Care4Care? Within their community, people (usually) over 50 will be encouraged to perform C&S tasks for neighbours within a reasonable walking distance. The time invested in these actions will be credited to a personal C&S account (like a bank account). The balance on the account will give the individual who has invested their time in providing C&S for others an absolute entitlement to C&S time when they will need it, later in life. In principle, the scheme works like a pension, with individuals receiving a quantity of care credits related to their input; but rather than the input and accrued funds being money, the currency is time and is therefore unlikely to be inflated or devalued. This scheme will supplement any basic, minimum care cover provided by the state. Within agreed parameters, free credits can be allocated to people who, for one reason or another, are unable to earn entitlements.
Even now a large proportion of C&S is provided by family, neighbours and charities; these so called ‘informal carers’ make great sacrifices in time, earning opportunities and careers, but one day they also will need C&S. A criticism levelled at the Care4Care concept is that it destroys true, pure volunteering given without any thought of reward – the kind of care given by these informal carers. However, we do not believe there will be anywhere near enough volunteers to cope with the relentless C&S requirements of an increasing number of frail, old people. Care4Care offers a way for ‘informal carers’ to have their contributions recognised should they choose to take part, and a scheme that faces up to the future and seeks to put in place an approach that responds to the inevitable financial, demographic and societal pressure that we face.
It is not the intention that Care4Care will cover all of the population; there will continue to be a parallel private market in which C&S is purchased at the point of need by those who are able and wish to do so, or by those who have care insurance. As such, we see Care4Care as part of the C&S landscape, available to all, but used by only those who choose to take part.
The Present (how it often is, when a public or a commercial service does its best.)
Tuesday, 2 November, 10.07 a.m.
Harry is waiting to get up and have breakfast. Harry always seems to be waiting. That’s one of the things about getting older and having to rely on other people for help with the basic things in life, like getting out of bed, getting washed, getting dressed, preparing food. When you can’t care for yourself, you have to wait for care from others. And it isn’t always available at the times you’d like – you have to fit in with the schedules they set. Harry understands; but it doesn’t stop Harry from feeling helpless, hungry and alone.
Gerry is running late. Gerry is sitting in traffic – willing the cars ahead to start moving. Gerry’s next call today is to Harry who, Gerry knows, will be laying in bed, waiting for help to get up and start the day. It’s not Gerry’s fault that Harry’s day has to start later.– Gerry can only be in one place at a time, and Harry is the fourth visit on Gerry’s list.
Scenarios like this happen every day. All over the UK people wait for basic comfort care and support that is often delivered at times that don’t really meet their needs. Professional carers travel from client to client, giving as much time as they can – and the system can afford – but often not as much as the person being cared for wants, nor at the time that’s best for them.
This situation is only going to worsen – unless, that is, we look for alternatives that enable a different approach to comfort care and support; alternatives that, as Niklas Blanchard puts it, “join otherwise unmet needs through otherwise unused resources”. Support provided by local people, for local people in a cooperative model of true community care where everyone gains by taking part.
The Future
Wednesday, 3 November, 7.45 a.m.
Harry hears the doorbell ring and the key turn in the lock of the front door. The visitor is logged as they enter; another care hour to be credited to their personal care account. Harry doesn’t have to look at the clock to know what time it is – Coreen is always on time. Not that she has to come far. Coreen lives in the next street to Harry and has taken on the role of his breakfast carer before she goes to work – it takes an hour of her time to help Harry get up and washed, then dressed, before giving him breakfast while they chat about yesterday’s events and the morning’s news headlines. Coreen shouts to Harry, who hears her filling the kettle and putting it on, before she comes into his room to help him. They smile at each other. “Ready for another day Harry?”, Coreen asks. Another day – and it starts with another small but vital chunk of time that helps keep Harry happy, living in familiar surroundings, with a sense of independence; an hour of companionship between neighbours who care about their community; and an hour that Coreen has ‘banked’ as future care for herself.
When Coreen gets home that evening, she thinks about her own future, when she’ll be Harry’s age. She feels more secure knowing that, when the time comes, she’ll be able to use the credits she’s earned for her own care and support. By then there will be a new generation of ‘Coreens’ to provide her care; a generation committed to building up their own care accounts.
Concept
Care4Care is an approach that rewards individuals for providing comfort care and support (C&S) and maybe more, to members of their local community, translating time spent on C&S tasks into credits in a personal care account. Care4Care treats the time given by supporters as a soft, or complementary currency. The balance accrued in an individual’s account may be ‘spent’ on his/her own C&S care when the need arises. This reduces the financial outlay on C&S required by both state and individuals while generating community cohesion through citizens providing local C&S in ways that fit their lifestyles. As such, it is not volunteering; it is work that accrues credits in the Care4Care system currency for future redemption.
As a concept, Care4Care has been in development for the past three years, during which time Professor Wolff has undertaken significant background work, testing the concepts with a range of stakeholders through meetings, presentations and interviews. This has led to increased public interest, through national reporting of the idea on television, radio and in print, and has identified a set of potential contributors who have shown strong interest in backing and working on the approach.
Advantages
The Care4Care approach has a number of strengths and benefits over aspects of state-offered/purchased C&S:
· it promotes mutuality and offer opportunities for powerful behaviour changes in individuals through participation in the scheme;
· it is based on mutuality, freeing state resources for other care, particularly the costs of medical care which will also rise as the population continues to age;
· it reduces dependence on the state;
· it builds community and promotes values around caring for each other;
· it has in-built, powerful quality assurance by word-of-mouth given the local focus of care;
· because C&S will be provided by a large number of local supporters, there can be time sensitive, appropriate delivery of care to suit the individual being cared for;
· it operates like a pension, but without the inflationary pressures on the currency; an hour saved now remains an hour no matter when it is redeemed;
· because it offers home-based care, it promotes and supports continued independence for the elderly;
· as a complementary currency, it “counteracts money scarcity [which is] essential in times of crisis” (Bernard Lietaer) and “joins otherwise unmet needs through otherwise unused resources” (Niklas Blanchard);
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Challenges
The Care4Care scheme has several dimensions that require careful thought, debate and planning before moving into the trial phase. These include:
· the ‘rule book’ which defines, both the earning of credits and cashing them in.
· how, and at what rate, those who legitimately cannot act as supporters (such as the armed forces or people with disabilities) can accrue credits;
· the optimum way to log activities and generate credits in Care4Care accounts;
· the model of operation of the scheme, for example as a federation of local schemes with a central clearing house for credits, or a national scheme with tightly prescribed, centrally-determined rules;
· the legal implications of the scheme and its interaction with the existing legal framework (such as safeguarding, data protection and tax);
· whether credits can be transferred to others, and if so what restriction might be placed on transfers;
· whether there should be a monetary element alongside the time credits earned to allow spending on items like stair lifts or mobility aids;
· the type and level of training that supporters should receive and how it might be delivered and financed;
· what the nature of the body who runs Care4Care should be;
· how care should be allocated if demand for care outstrips supply of C&S;
· understanding behaviours/responses to the Care4Care approach for different demographics of both cared-for and carers;
· modelling population and age profiles to better understand the sustainability of the system over time;
· to learn from and critique existing models in the area, such as Japan’s Fureai Kippu care system, which was establish in 1995.
It has to happen!
