Activating the Unrealised Potential of Care Networks

cross-posted from the Equal Care Cooperative blog

Equal Care's pilot in Commons-based care in Hackney builds on five years of work developing and delivering a ‘teams model’ of home care in Calderdale, Yorkshire. Taken together, our current teams and new commons approach seek to resolve two fundamental problems with the traditional service model, a disconnection between:

1. The care worker, the person receiving care and their wider support networks
2. The care provider and the community networks that are present in the neighbourhoods they provide care in.

The successful piloting of our teams model over 2019-2021 addressed the former problem by realising the full potential of the relationships between care worker, the person receiving care, and their wider support networks. Piloting our commons approach in 2023 seeks to address the latter problem by activating the unrealised potential of the relationship between our teams and the local community networks.

Traditional Services: ‘The Deliveroo model’ of care

Most care services use a ‘Deliveroo’ service model: Individual care workers deliver care as if it were a package to another individual's home. These care workers have no connection to that person's wider support network, their neighbourhood or community. They also have no freedom or control over their day-to-day work. This amounts to a service that provides care independently from the support networks embedded in people’s local communities; any collaboration with these support networks in service delivery is generally incidental to a services organisation rather than a direct consequence of it. This is OK if you really are delivering a package, as all you need is a postcode; it is not OK when you are providing care. Detached from these vital support networks and with no power or control over their day, care workers have extremely limited means of promoting the well-being of the people they support. Care is reduced to task-oriented transactions constrained by schedules and routines defined far from the point of delivery.  A Deliveroo model of home care alienates communities from the services they rely upon. Care providers are not perceived as part of the community they serve, but as outsourced services increasingly failing to meet their needs.

Teams

Equal Care recognises that care is a relationship, not a task or a problem to solve. We know that realising the high standard of care we provide depends on the quality of the relationships between the people giving care, the people receiving it, and their wider support networks. The key to good service design is developing systems that realise the full potential of these relationships. This work began with our “teams” model, successfully piloted in Calderdale Yorkshire. Our platform helps match caregivers and care receivers based on their character, interests and personality - rather than just on availability - ensuring that they are a good fit for one another. The platform also enables the person receiving care to build their own self-managing care team, meaning our care workers do not work alone; they work with that person’s wider support network. Working in teams enables us to go beyond task-based care such as washing, dressing and feeding, and focus more on quality-of-life needs. An individual’s wider support networks can enrich their lived experience of regulated care if we allow it to: Care and support can exist in abundance! We support each team to ‘self-manage” with coaching, training in peer-to-peer problem-solving and decision-making approaches, our tech platform and a suite of online collaboration tools.

The Care Commons

The recent pandemic highlighted and exacerbated a shortfall in formal support services for vulnerable people. It also, however, opened up new conversations about systems of care and support. Throughout the Pandemic, grassroots community networks increasingly came to the fore, plugging gaps in service provision and assessing and meeting needs in locally sensitive ways. The development of these networks not only had an impact on the lives of the people whose needs they sought to address but also on the diverse groups of people who participated in them. The experience of “mutual aid” within neighbourhoods helped to generate a greater sense of community and belonging as residents recognised that they not only felt accountable for the well-being of people outside of their immediate circle of friends and family but who lived close by. For many of those people who were most active in these networks, the greatest challenge to meeting people’s needs was not a scarcity of available care and support but difficulties in coordinating and managing this abundant resource as well as connecting it to people who were hard to reach. Keeping local community networks at the margins of a formal system of support not only impoverishes individual care but also the communities that those people belong to. When care is allowed to flow through resilient community networks it can help generate the levels of trust, accountability and belonging that make for healthy resilient communities.

The word “commons”, refers to a community-run and owned resource. What we saw during the Pandemic was the role a care commons could play in sustaining individual and community well-being in a crisis. Social Care is in crisis, and just like the Pandemic, this crisis impacts us all. Since conventional home care services have been designed to address individual needs they often overlook the wider networks of care and belonging that those individuals are nested within; systems made up of friendship groups, families, neighbors, and local community networks. In the day-to-day delivery of services, these networks have been sidelined. Friends, family and community members have been placed at the margins of formal systems of care. Until recently these "informal" carers placed their trust in the professionals and their processes and procedures. However, the devastating impact of over a decade of austerity has almost completely eroded this trust. Lacking confidence in these formal systems of support, more people are placing their trust in informal systems of support.

Our pilot rejects an either/or choice between professional services and the kinship and community networks we belong to, choosing instead to overcome the disconnection between them. Taking a commons-based approach is about engaging the best of these two vital support systems, developing a hybrid service out of the relationships, systems and processes found in both these domains of care.