(Did you know? We just got approved to become a home care provider! Get in touch with us at firstname.lastname@example.org to find out more.)
Wow! We are now more than halfway through our trial of Lively Home Care. Over the course of the last seven weeks, thirteen older residents of Darebin Council area in Melbourne and three young helpers aged 18–23 have been working together to try out a new vision for home care. During this time, the helpers, who have no formal training in caring outside of that provided by Lively, have been providing a helping hand, support and companionship to our Lively “Members” — the older participants in our trial. Together, we’ve been exploring how Lively can bring young and old together to support one another.
Testing our principles
In our second post, we outlined some starting principles that we assumed, if we adopted them, would add up to a strong model of support that meets older and younger people’s needs. These were:
- Openness, Transparency
- Flexibility and Creativity
But as we talked about in our last post, even though we had a lot of ideas about what it might look like to put these principles into action, we in the team knew we were making a lot of assumptions. It was important that we explore these ideas together with older and younger people to find out what would work for them.
So we took these principles and used them to develop a series of trial learning questions, which have guided the activities we’ve chosen to run. Throughout the trial, we’ve been poking and prodding, pushing and testing these principles by:
1. Putting them into practice: We’ve done our best to run a simplified version of the service we eventually hope to run — a service which is underpinned by these principles.
2. Exploring them through co-design workshops: Over the course of three half-days, we, the members and helpers have shaped our intake processes, developed policies to respond to tricky scenarios, dreamed up new ideas for the service, and importantly, debated what aspects of the service and principles it’s most valuable to carry forward.
We’ve learned a tremendous amount through this process, and we’re hugely grateful for the energy and intelligence our members and our helpers have brought to the table. We’ll be putting together a more complete summary of some of our insights once we’ve wrapped everything up. But at this mid-way point, we wanted to share what we’ve learned about two principles in particular which have generated a lot of discussion and debate amongst our participants.
Rowlina, Lorraine, Paul and Janet discussing how to tackle tricky scenarios that might arise as part of a home care service.
Flexibility and Creativity
Starting out, we were keen to find out whether some of our ideas for a flexible service would work for older people. We’ve mainly tested this principle out through practical application, through the design of the trial service. In particular:
1. Members and Helpers have control over the care plan. The tasks and activities that are causing us stress can change at any time, and care plans need to have sufficient room to allow people to make changes easily to reflect their own changing needs; unfortunately, most home care services require these changes to be requested through a case manager in a central office, meaning that bureaucracy and time delays can get in the way of people getting on with what they need in the moment. In the trial, Members and Helpers have the ability to change the care plan, and are trusted to manage it responsibly without having to run everything by a case manager, except where there is particular risk involved. Members and Helpers have access through our online platforms where everyone’s information is stored and managed — a system we’ve patched together for the trial using simple free or low-cost online tools like Slack, Google Drive and Harvest. It’s low-fi, but it’s done the job!
2. Many different support services are wrapped up into the helper role; they are trusted to help out with a whole range of different tasks that members might need doing — much as a child or grandchild ordinarily might — from pruning the roses, to taking the bins out, to providing transport to social outings. This means when a Helper comes to visit, Members have quite a lot of freedom about how they choose to spend that session together.
3. Responsibility for scheduling has been decentralised to Helpers. By being in control of their own schedule, helpers can liaise directly with Members to organise visits and reschedule appointments. By not managing the rostering centrally, we remove one layer of extra communication Members have to go through to organise or reschedule their sessions, and maximise the actual interaction they have with their Helpers. It also addresses a common concern for older people that centralised rostering often results in little continuity in the workers who visit them, forcing people accept strangers coming into and out of their lives on a daily basis and leaving them feeling powerless.
What these approaches have produced in practice is a community of participants undertaking a diverse and creative series of activities. Helpers aren’t just cleaning: they’re also doing basic gardening, going on shopping trips, supporting members to go on social outings, helping people with technology, coordinating contractors, reading memoirs, and supporting people to downsize. The roles are dynamic and varied.
What has been striking is that, perhaps more than any other element of the service, our members have been overwhelmingly appreciative of the flexibility we’ve been able to provide. We recently gave everyone a call to have a chat about whether they feel their needs are being met. Here are some of their comments:
“The amount of flexibility with your program is amazing… For somebody like myself who has multiple disabilities, who physically can’t do things I used to be able to do easily, having this process of being able to have somebody there who does those little things, it’s almost quite humbling because there’s nowhere else I can get the help… I think the whole concept is really good. It’s very, very good. It’s very comforting.” — Anne-Marie
“It’s exceptionally good. I wouldn’t have the flexibility if I was with a government thing… They’ve got all these set ideas: ‘You’ve got to do housework. That’s how you help people’…” — Lorraine
“I’ve never been in this position before to be so grateful for the help that you have offered.” — Willeke
“She can do things that Council people can’t touch.” — Pam
We were very encouraged to receive such a ringing endorsement for this fundamental principle of Lively Home Care. It affirmed our belief that, when given the support to work together independently, older and younger folk can be endlessly creative and resourceful.
Anna and Maree working through one of the thorny questions we put to our participants!
Reciprocity and exchange
One of the most exciting and potentially transformative features of Lively Home Care is in the way in which we try to think about older people’s participation in Lively. Rather than treating older people simply as purchasers of our services, we wanted to test what it might mean to treat them as active participants in our community, in which they are supporting young people as well as being supported themselves. In the context of this trial, we’ve tested out the concept of “reciprocity” in the following ways:
1. We have, from the outset, made clear that our helpers may not have previous experience in caring, and that the members may need to show them how to do certain tasks with which they may not be familiar. In this way, they are providing an opportunity for young people to gain experience and grow their skills.
2. In our latest workshop, we talked through a series of ideas for different ways in which members could be invited to contribute to the Lively community, such as:
- Helping mentor their Helper
- Acting as a welcomer to new Lively Members
- Running courses or instructional programs for Lively community Members
- Participating in ongoing Lively service co-design
Helper Ashleigh and Member Janet discuss ways we could be helping support community connection through Lively membership.
This was the cause of a lot of discussion, and some disagreement amongst our participants. It became clear that some of our ideas needed a bit of re-evaluation and refinement. In particular, although our hunch had been that Members might feel a sense of empowerment from being invited to contribute their skills to Lively or to their Helper, some Members were suspicious of a model of care that emphasised an expectation that they should be contributing their time and energy. They (not unreasonably) wondered why they should be expected to contribute more to a service for which they were already paying. For example, although for a free trial of a service Members were happy to be giving their Helpers pointers, they understandably felt they may have less patience for this once they were paying for the service using their government home care package.
Some Members also felt that, while the culture of reciprocity might be attractive, it was more likely to be attractive for those people whose needs were less complex, for whom it might be most important that the job gets done as efficiently and with as little fuss as possible. They pointed out that the need for self-determination was lower down on Maslow’s Hierarchy for those who have more pressing and complex support needs.
Rather, our Members valued a sense of “relationship” and meaningful connection with their Helper which they felt developed organically. They felt that this had arisen naturally out of their work with their Helper, and didn’t require specific activities that enabled them to “contribute” in a specific way to their development.
We also learned a lot of people have trouble saying “reciprocity.” That word may need to go.
Nonetheless, when presented with some of our other ideas for ways they might be able to participate in Lively’s service, there continued to be significant interest in the ideas we put forward, such as in the exercise pictured below.
What we learned from this, then, was not so much that “reciprocity” was necessarily flawed as a principle, so much as that:
- People value their relationship with their Helpers. But we don’t need to force a“reciprocal” dynamic between them. A lot of the time, it just happens.
- There is appetite for broader opportunities to contribute to the Lively community, but if there is a perceived expectation that Members do so in addition to paying for the service, this would actually undermine the feeling of reciprocity. Members expressed a feeling that they would be giving an unreasonable amount and not receiving enough.
What this has taught us is that our ideas are on the right track, but that we need to be careful how we articulate them. Members need to know that by paying for Lively’s services, they are already meeting their part of the bargain as part of the principle of “reciprocity”, by making a vital financial contribution to support young people’s employment.
We’re learning heaps, but sadly our trial wraps up in just over two weeks, and we’ll be gearing ourselves up for the next phase of Lively Home Care!
Last month we received confirmation that the government gave our application the tick to become an approved home care provider, and we’re hoping to hit the ground running in Melbourne as early as October!
If you or someone you know is looking for a hand at home, get in touch with us at email@example.com, and find out how we could work with you.