Last week upon my return from holidays, I did a pechakucha (a presentation format where 20 slides are shown for 20 seconds each; total of 6 minutes 40 seconds) about innovations in elder care. The slides are viewable below with the accompanying explanation. (Note: a version of this post also appears on Think Thrice)
In 20 years, Canadians aged 65 years and older will account for roughly one quarter of our population. But our elder care system is already strained and looking more and more like an assembly line, with our loved ones being commodified.
These issues are close to my heart because for the last six years of my father’s life, we navigated the healthcare and elder care system together. We experienced a system that is more about keeping people alive than about quality of that life. Particularly in nursing homes, I witnessed very upsetting losses of dignity. I have since learned of exciting and inspiring approaches to elder care from around the world that we need here in Canada. I will share three.
This first model comes from Denmark’s Fredericia Municipality and got started because of a pair of socks. Imagine I’m an elderly woman and I’m having trouble putting on my control socks. Instead of a caretaker coming to my home twice a day to put them on and take them off, under this new model…
… a personal trainer would come to my home and work with me to get stronger on a 6-8 week program so that I can manage my socks myself. There are immediate cost savings (8 wks vs. twice daily forever) and preventative cost savings to the health system since I am healthier in general.
Most importantly, from the citizen perspective, I can walk up the stairs with more ease, play with my grandchildren, and am more comfortable in my own body. I feel empowered by the system, not at the mercy of it. A big part of the model are sessions like the one pictured here where professionals come together to co-create the senior’s rehabilitation plan with the senior.
They ask a very simple question… “What would you like to be able to do again?”, focusing on bringing back the ability to function in a self reliant way. The public service is treated as an intervention rather than a long term relationship with the citizen.
The model is gaining popularity in other municipalities in Denmark. According to MindLab, it is rumored that two thirds of Danish municipalities are using some form of the Fredericia model. The previous director of care in Fredericia has stated that the model provides an efficiency dividend of around 15% annually. This is all while increasing citizen satisfaction and quality of life!
The next model is from Japan, where the nursing home system had long been two tiered: either low quality of care or extremely costly and thus out of reach for most. Also, nursing homes were less culturally accepted because it was thought to be honorable to take care of ones parents into their old age, despite the strain this may have on career paths and personal lives.
The Shinkoukai model addresses quality of care and affordability in three unique ways: it has a social impact element by employing marginalized citizens (including homeless, disabled and non-Japanese Asians), it ensure high quality care by gaining third party certification (the ISO-9001, a quality rating used by restaurants and hotels), and minimizes costs by purchasing unused buildings (farmhouse, university dorm, office buildings) and converting them into nursing homes.
The founder of the model, Masue Kitayama, has been working on elder care challenges for over 40 years and has become one of Ashoka Japan’s first two fellows. She is credited for catalyzing change to insurance laws, that initially only insured incapacitated seniors, but now also covers seniors who require less care.
Masue’s impact can be seen manifested in the growth in number of care homes across Japan: from 2500 in 1985 to 7300 in 2009. She just opened this intensive care unit, picture here, a couple weeks ago.
This last model is a different approach to rest homes; it is a cohousing model for seniors started by a group of aging feminist activists in the Paris suburb of Montreuil. These women had fought for their rights their whole lives and were not interested in living by someone else’s rules or schedule as they got older.
The idea is simple: Rather than moving into a seniors home, the women would live together in a large house and take care of one another. No professional staff, like nurses or cooks. They would be free to live as they chose.
This model was created by Therese Clerc, who, in her 60s, began thinking hard about how she wanted to live in her old age. To learn more about her options, she began visiting seniors homes and talking with residents about their experiences.
Appalled by what she learned, she rounded up a group of friends and began lobbying French politicians to fund what became the baba yaga’s house. It took 13 years, but the women eventually convinced funders to construct a six million dollar six-story women’s only seniors home. The women moved in October 2012.
All of this inspired Montrealer Janet Torge to start tinkering with the baba yaga model to see how it could be replicated in Canada. Based on the same co-housing principles of living together without professional staff, Janet’s radical rest home concept is about getting together with a group of friends to find a place to live. Once you’ve moved in, you declare yourselves a radical rest home.
She is envisioning a Radical Resthome Association, which is currently a work in progress, to help with setting things up, figuring out resources and connecting with the broader rest home network. There is another group called Baba Housing in Canada that was inspired by the Montreuil babas, which have ambassadors in many cities across the country.
These models give us a glimpse of what is possible. But, as artist activist Ai Wei Wei put it:
“the world is not changing if you don’t shoulder the burden of responsibility”.
In other words, it’s up to us. What would it take to implement these models in Canada? How can we shift our elder care to models that emphasize thriving not just surviving? How can we design systems that empower seniors to be self-reliant and make their own decisions?
I didn’t have time to mention these other aging and elder care initiatives but they are also great. Here are the links:
- The Amazings: Classes, courses and wisdom from elders with amazing life experience
- Fureai Kippu: “Caring Relationship Tickets” are based on the time bank concept; allow people to help seniors in their community and earn credits transferable to other cities
- Tyze: online tool that helps people care for others
- Merevale House, UK20: small-scale domestic living where people are seen to be living and working together, sharing their community and daily life
- Carebanks, Timebanks: helps seniors age-in-community irrespective their economic situation
- Visiting Nurse Service: high-quality health care in the home and the community
- Lotte House: nursing home where 23 men and women live like a family
- Aging Studio, HDL: The Studio set out to articulate a new understanding of the ageing population
- Age Unlimited, NESTA: program developing and trialling new services for 50-60 year olds to continue contributing to society
- Weavers, InWithFor: Helping people balance caring with the rest of life
- AgeLab MIT: innovation lab that designs, develops and deploys innovations focused on aging
- Southwark Circle, Participle: membership-based service supporting +50 year olds to lead the lives they want to lead.
If you’re inspired and want to do something about this topic, let’s talk! Or, you can reach me via email or twitter. Also, I will be adding to the thinkthrice.ca/eldercare page as I go.