‘It’s the principle of it’: how we’re building a home care model based on principles
Those who read our kick-off post will know that at Lively, we’ve been playing with an exciting idea; the idea of re-imagining home care, and developing a home care model that employs young jobseekers to help older people stay connected and live well. We’re driven by a vision of a world in which young and older people are better valued, connected and supported in our community. So we’re exploring how an intergenerational home care model could not only provide the supports older people need to get the most out of life, but also provide opportunities and spaces for older people to share their experience, skills and knowledge back with the young — fostering mutual exchange, and positioning older people not just as ‘people to be looked after’, but as valued contributors to the development of the young.
Getting started: having conversations
When we set out to explore this idea and bring it to life, we started with a few key questions:
1. What would great care and support really look like from the perspective of older people and their families?
2. How would the proposition of a young person who is less like a ‘care worker’ and more like a ‘grandkid who comes and helps out’ land with older people and their families?
3. How could we foster meaningful connections and relationships between older people and the young people who come to help them out? Relationships that are two-way and based on mutual exchange, rather than positioning older people as passive ‘recipients of services’?
4. How would young people respond to this model? Would they be interested in providing these broader supports, and how far would this interest stretch?
At Lively, we believe that the only way of answering questions like these is to get out and talk to the people they concern. So we hit the road and started talking to as many people as we could — young people, older people and their families — to find out about their experiences, their needs, their aspirations and their ideas. We were perfectly willing to be told that we had it all wrong, and that neither young nor older people would be interested in this model. And we were ready to hear and be directed by the ideas and the preferences they put forward. We used a combination of interviews and activities to start teasing out and understanding people’s views, and to articulate what they would be looking for in a best-case home care model or employment scenario. We used ‘spectrum’ activities as shown below, and card sorting that asked young and older people to indicate things that they would or wouldn’t be attracted to. We also brought young people together for a few workshops to test out ideas and get a sense of what would or wouldn’t work for them.
Through these processes, we learned A LOT. And a lot of it was really exciting. Like the fact that…
· Young people were keen to provide broader supports — many were even willing to provide personal care (such as showering, toileting, etc.) as long as they were taught how to do this properly (this surprised us!). They loved the idea of being able to play a really meaningful and significant role in older people’s lives, and were attracted to the idea of managing their own schedules and taking responsibility for their work.
· Older people and their families had no qualms about the idea of working with a young person who ‘needed a go’ over a more experienced professional. In fact, many older people particularly liked the idea of getting to know the young person on an ongoing basis, and being able to share some of their knowledge and experience back with them. While one or two we spoke to already felt quite socially connected and didn’t feel the need for a particular connection with their helper, most loved the idea of relationships that recognise their ongoing value and capacity to contribute, rather than treating them as ‘old people to be looked after’.
· Everybody loved the idea of a flexible service with plenty of room for creativity in the types of support older people could access from their helpers, and for changes to be made quickly and easily when needed.
Most importantly, people loved the idea of a service that would be less business-like, less process-oriented and more fundamentally human.
To cross-check and validate what we’d heard through the interviews, we also spent a lot of time reviewing existing research and speaking to people with knowledge of the field. These included people currently working in aged care or for peak bodies, or carers who had been involved in navigating the system on their parent’s behalf. These conversations gave us some incredibly valuable extra perspectives and insights, and helped provide confidence that what we were hearing from the older people we spoke to was likely to be the case for other older people too.
Bringing it together: developing our principles
And so, through this interview process, some strong guiding principles for our home care service emerged:
- Reciprocity and exchange: We know that having agency and feeling able to contribute plays a key role in our wellbeing. For that reason, it’s important to us that older people are not just ‘recipients of services’, but equal and valued contributors to the exchanges and relationships with their young Lively ‘helpers’, as well as to Lively on the whole. Opportunities for older people to contribute and share their interests, talents, knowledge, ideas and experience should be promoted wherever possible.
- Self-management: Older people and their families know their needs best, and should therefore have control and authority over the support they receive. Equally, young helpers know their own skills, capacities, availability and limitations, and can work with older people to co-ordinate their care in ways that work for them both. We are here to step in and support people only if, when and as they need us to.
- Connection: Human connection and meaningful relationships are at the core of everything we do. Conversation and connection won’t be sacrificed in the interests of time and money, and are as important to us as the transactional ‘tasks to be done’. Our role is to facilitate a connected ‘community of care’ between young and older people — not to be a ‘service provider’ — and to help people build and strengthen the support networks around them to maximise their ongoing connectivity.
- Openness, transparency: Older people, families and young people deserve full visibility of the ways in which our community and organisation is run, and opportunities to contribute to its shape and direction. We must communicate openly, honestly and regularly, and respect people’s ability to understand information and participate in decisions that affect them.
- Inclusivity: Our services must be safe, open and welcoming to people of diverse backgrounds and characteristics. We will ensure that LGBTIQ, CALD, Aboriginal and Torres Strait Islander and other diverse groups know that they are welcome and valued in our community of care.
- Flexibility and creativity: The best outcomes for individuals will be achieved when they can shape their experience and services to suit their needs. We embrace opportunities to work with young and older people to try new things, and to find new and better ways of doing stuff. And we won’t set up systems and processes that are too rigid to respond to what people really want and need — including as this changes.
- Friendliness: Being generally warm and friendly people is the bedrock of everything else we want to be and achieve.
From these principles, lots of exciting ideas start to spin off. Like ideas for how we can set ourselves up to enable genuine self-management for young and older people. Or how we can enable young people, older people and their families to connect and communicate seamlessly to co-ordinate care and support. And how we can encourage and facilitate opportunities for older people to share and contribute back to the development of the young. Right now, all these ideas look a bit like this:
We’re really excited about lots of the possibilities on the wall, but we also recognise that they come from us in HQ rather than from the young and older people we want to work with. Which is why it’s time for us to hand things over to them before we go any further! Our next step is to bring together a design group of young and older people to start fleshing out the ideas for how our service will operate, and to put those ideas into practice — testing, evaluating and refining them together as a group. Rather than participating in a ‘co-design meeting’, then going back to their everyday lives, our ‘co-design’ participants will be designing, using and refining the service with us in real time. We’re calling it ‘co on the go’!
We’re currently recruiting a group of young and older people to ‘co on the go’ with us over a 3-month trial project, during which we’ll all start to define how our principles should be put into practice, and test out how that would actually work. While there’ll be lots of ideas and possibilities flying around, having the principles in place provides us with a really firm ground and foundation against which everything we’re testing and observing can be assessed and measured. It’s going to be an exciting time, and in our next post we’ll share more details of exactly how we’re running the trial and the participatory approach we’re taking. In the meantime, we’d love to hear from others who have experimented with similar design methodologies, or who have ideas or reflections on our principles and approach. Comment below or follow us for our next update!