Part II: Senior Healthcare | Southwark Circle

Participle is innovating new approaches to ageing. Since September 2007 they have been working in a unique public-private partnership with Southwark Council, Sky and the Department for Work & Pensions, to design new services that will improve the quality of life and well-being of older people. Working with over 150 older people, they have developed Southwark Circle, a membership organisation that helps people take care of household tasks, forge social connections and find new directions in life. Open to all, regardless of levels of need or income, Southwark Circle is a model of how future services might look across Britain.

This is a social reform challenge, not just a public service reform challenge. The question is not just “What can public services do to improve quality of life and well-being for older people?” but rather “How can a locality mobilize public, private, voluntary and community resources to help all older people define and create quality of life and well-being for themselves?”. This requires radical change in the way resources are defined (beyond the formal social care system) and the way services and systems are configured (away from a near exclusive focus on care and towards building relationships and participation).

Public funding is just one among several flows of resources that go into the support of older people from unpaid carers, voluntary groups, paid-for services, and peer-to-peer support. Public services and systems must be re-designed accordingly. An effective approach must mobilise resources and activity from all these sources, not just redesign the public component.

Participle has developed early answers to these challenges in this project. They have worked with over 150 older people and family members over the last nine months.

The project started with two months of user research with older people and their families, generating insights into their hopes, fears, needs and aspirations. Based on these insights, they generated over 50 ideas for new services. They decided to focus on a service that would create a rich third age, and have spent the last five months refining our proposition, developing prototypes of the service and co-designing with older people and their families. They have tested models of the service with users and recruited people to take part in a rough trial of the service. They have developed a business case, received initial investment and will start to build the actual service, continuing to test with users over the next few months. Responding to demand, we plan to launch the service as a social enterprise in Southwark in early 2009. They also plan to work with additional local authorities to develop a national model.

Part I: Senior Healthcare | Helping our elders live independently for longer in their home environment

With the US elderly population potentially doubling by 2030 from 36 million to 72 million; an estimated 45% drop in formal or professional caregivers over the next 30 years; and a national health expenditure projected to rise from $2T in 2005 to an estimated $4.1T by 2016, it's clearly become a necessity to think innovatively around services for our growing senior citizen population. Currently, 78% of all at-home, long-term care is provided by informal caregiving networks i.e. friends and family members. As seniors push to live independently for longer in their home environment, the effort on the part of these caregivers creates enormous responsibility and even burden, which in the end may not be sustainable. With a growing senior population living longer, the strain on dwindling financial and caregiving channels, we may find ourselves at a breaking point very soon.

Right now, there's considerable effort going into rethinking how services could and should be provided. We're starting to consider new distribution models for federal dollars as well as some intriguing ideas around co-operative services between seniors' social and local networks. Below is a summmary of a case study sponsored by Harvard's Kennedy School: Ash Institute for Democratic Governance and Innovation. The study looks at a new distribution of federal dollars in China.

The government created "Purchasing Services for Senior Citizens at Home," to ameliorate the difficulties of older persons living alone. Rather than involving itself in the details of providing services to the elderly, the government supported creation of this program to manage daily operations. It secured cooperation with local civil organizations and subsidized them for performing functions that were previously carried out by government. It has been successful since inception as it is grounded in extensive social participation.

Services are now "purchased" by either individuals or enterprises. Many elderly do not pay at all; the services are "purchased" for them. The word "purchase" is used uniquely, as purchasing is often entirely subsidized by the government. Any qualified senior can receive one hour of services at government expense. Seniors who do not meet the requirements for services can still participate as many services are offered by volunteers. Those who can afford to purchase services may choose to buy additional services on their own. Additionally, an emergency telephone number "81890" is available for older people who live alone.