“If you have come to help me, you are wasting your time, but if you have come because your liberation is bound up with mine, then let us work together.”— Aboriginal Activists Group, Queensland, 1970s
This quote, born out of Australian indigenous activism, neatly expresses how we want to think about Lively Home Care; it acts as a compass for us as we navigate the uncertain territory of designing a new model for caring. For this group of aboriginal women, the statement rejected white paternalism, affirmed their power to recognise the solutions to their own challenges, and asserted their intelligence and personhood. For us at Lively, as we confront the struggles older people face in receiving proper support to remain independent at home, this quote reminds us that our mission is not to “help” older people. Rather, it is to work alongside them, and to recognise that a system which dehumanises and marginalises older folk harms us as well; we will all be older people (we hope!) one day. We also all benefit from an engaged, mobilised and empowered older population who can continue to contribute to the life of our community.
When we position our older friends as beneficiaries of our generosity — as passive recipients of our help — we maintain the ageist attitude that older people are incapable, needy, or burdensome. But when we recognise them as allies in solving a shared challenge, we start to break down our misguided views about ageing and those who started it before we did. In case we needed more reason, there is also ample evidence showing that disempowerment and marginalisation have severe effects on our physical and mental wellbeing.
This principle forms the rock-solid core of our model: that older people and younger people will benefit from working together. You can read more about Lively’s model in our previous post. We also have the luxury of being in a position to build a model from the ground up, which is why we can start applying this principle right from the beginning. And that’s why we’re co-designing Lively Home Care.
How do we co-design?
“Co-design” is a bit of a buzzword right now. For the reasons outlined above, a lot of social services and government departments are recognising the need to be involving their participants or users in the design of their services. At best, it can be a genuine way of sharing power over the design of systems that people use; at its most ineffectual, it becomes another kind of “consultation” process with users, leading to very little concrete impact on the way services are run.
But co-design, at its most meaningful, is a power-sharing process. To borrow Slay and Stephens’ (2013) definition, co-design/co-production is “a relationship where professionals and citizens share power to plan and deliver support together, recognising that both partners have vital contributions to make in order to improve quality of life for people and communities.”
The theory is that this results in services that centre people’s experiences and journey with a service, rather than being designed from the top-down, resulting in a better, more human experience. But for many it also achieves a broader philosophical goal, handing power back to people who have been traditionally marginalised by systems, and ideally building their confidence to speak up and represent their own interests.
In our case, that means divesting the Lively staff and Board of the responsibility to make decisions independently about how Lively Home Care should look and operate. Instead, we’re bringing together our staff, our Helpers, older people and others to work together to make decisions about how a home care model could solve two problems: young people’s employment challenges, and older people’s need for flexible support to remain living at home.
How we got here
We’ve spent a lot of time setting ourselves up to run our co-design project. For us, the most important thing to work out was: what are the project’s parameters? We recognised that there were certain limitations on the decisions our co-design group could make, and we’d need to make those explicit so we could provide the co-design team with a clear set of guiding questions and meaningful choices about how we could operate.
Firstly, we recognised that we had already reviewed a lot of the available research about Australia’s home care system, and the challenges it faces. We also already had certain ideas about the shape of the final service, based on the conversations we’d had already with professionals and with older people. We were likewise aware that we would be bound by the complex legislative and regulatory guidelines that govern Australia’s home care system.
To ensure that we could be clear with participants about these parameters and how they would contribute to the co-design process, we had to spend a bunch of time working out what we thought we knew and what we didn’t. To do this, we took the following approach.
1. We went through a lot of research, examined a lot of reports, read and listened to a lot of stories of older and younger people.
2. Off the back of this, we developed a working set of principles (outlined in our second blog post) that reflected our understanding and shared assumptions of what we’d learned good care could look like.
3. We went and chatted to older and younger folks in interviews about what they thought of our principles, and some of the concrete ideas that we’d come up with to embody them. Through this process, we heard that the principles we’d developed were broadly on the mark, but we also refined our understanding of whom our offer best suited — those whose needs are slightly less complex, but who may be experiencing a degree of social isolation.
4. We knocked up a complex ‘service blueprint’ that represented our best guess at what a service informed by these principles would look like, sketching how we thought the different moving parts would interact.
5. We went through our blueprint and worked out the greatest areas of uncertainty — which elements were still heavily based on our own assumptions about what older and younger people wanted, or how they’d behave.
6. We turned this blueprint into a simplified skeleton for our service, complete with our learning questions and areas of uncertainty that we wanted to work with our participants to explore.
Our simplified participant journey supplied to trial participants.
From this point, we felt we had sufficient clarity to be able to clearly define the scope of the task we were setting our co-design participants, and work with young and older people the opportunity to fill in our assumptions and areas of uncertainty with their own views and ideas. We wanted to set up a space in which we could all contribute equally to how the service would look and feel. To make the approach meaningful, we decided that the participants in our co-design process should also be the users of the service they were co-designing — something we’ve nicknamed ‘co- on the go’. We figured that people would be able to share more meaningful feedback and perspectives if the questions we were posing could be related to their direct experience of the service, rather than considered in the abstract.
So, with the financial support of the wonderful people at The Funding Network who saw promise in our model, we set up a trial that could run as a rough assimilation of our service. In the trial, a small group of older folks would receive a bit of free support from a group of younger people we would employ, and both young and older people would work with us to iteratively design, test, reflect on and improve the service experience.
It was important to us that this process properly acknowledged the time and skills brought by all participants, so in return for participating in design sessions, we budgeted to allow the older participants to receive around 3 hours a week of free care for 10 weeks, and the young people to be fully paid for their time providing this care and support.
If you read our last post, you’ll be excited to know (although maybe not as excited as us) that we‘ve just kicked off our home care trial. With the help of the amazing people at Darebin Council in Melbourne, we’ve reached out to older people who could use a hand, and 13 of them have come on board to start our design process. Here we are (minus a few):
We’ve also hired 3 enthusiastic young people from the area to participate. During the first workshop with our participants, we worked together to design an ‘intake process’ for new Lively Members, working out how people’s first interactions with the home care process will work, using the diagram above as a starting point. Over the next 2 weeks, we will be going ahead and trying out the ideas that the members of the workshop came up with. Stay tuned and we’ll tell you more about what they decided and how it played out!
Have questions/comments? Drop them here, or flick us an email at firstname.lastname@example.org!
A particular thank you to our friend Kelly Ann McKercher and the Australian Centre for Social Innovation for some of their resources surrounding co-design processes.
Slay and Stephens, 2013, Co-production in Mental Health: a Literature Review, the New Economics Foundation.