I. What is the innovation beyond franchising?

Complexity economics provides the framework for appreciating CareShares as an evolutionary innovation. TimeBanking has developed and evolved as a complex adaptive system. It has all-purpose flexibility but that has proven to be both an asset and a liability. CareShares has refined a combination of the strongest attributes of Time Banking: risk pooling, reciprocity, incentives and the production of public goods. It incorporates the consumer as co-producer of the outcomes – a strategy that enables TimeBanking to partner effectively with and enhance the performance of diverse human service systems. By restricting the focus of Time Banking, CareShares is designed to function as a disruptive innovation in the vast underserved market for informal care.

As Baby Boomers age, they desire to make a contribution. CareShares enlists that desire for civic engagement and rewards it by enabling them to use the Time Credits earned to secure “assurance” for themselves, their partners and their parents. In doing so, it builds on the insurance principle of pooling risk while providing freedom and flexibility to contribute by volunteering. The self-esteem provides a second reward reinforced by linkage to a social network of strangers who share similar values and who can be trusted as a new form of extended family. It redefines the selfish gene impulse to “reproduce” into support for progeny defined by values rather than by genes and lineage. It taps the residual capacity of older adults in a way that both the market and traditional volunteering have failed to do. It enlarges the economic pie through a win-win strategy based on a culture of co-operation, mutual support, engagement and trust.

Ever since its emergence, TimeBanking has been effectively creating informal networks to address an array of social problems. CareShares represents an evolutionary development that can realize the full potential of Time Banking because of (1) new design elements, (2) the significance of the sustainability strategy (3) delivery system impact and (4) implications for public policy. These are spelled out below.

NEW DESIGN FEATURES: the Time Dollar premium supplies enhanced, reliable informal support ? the dollar premium generates a sustainable revenue stream ? surplus hours channeled to partnering organizations expand civic engagement, provide reserves and trigger reciprocal obligation ? new web-based Community Weaver software reduces transaction costs, links families across neighborhoods ? data input by members (made possible by Community Weaver) personalizes exchanges and eliminates an historic bottleneck ? the franchise format reduces start-up costs, enhances quality control, shares expertise, enables evaluation

APPEAL OF SUSTAINABILITY STRATEGY: fiscal viability makes pooling risk a credible investment ? volunteer hours turn into future purchasing power ? the first pilot (September 2007 – Las Cruces, NM) secured immediate commitments of start-up funds from public and foundation funders and a statement of official intent to take CareShares statewide ? the social venture framework, by addressing the threshold question of sustainability has generated unsolicited action by one congressional committee, bi-partisan support and unprecedented expressions of tentative commitment by major non-profit organizations, faith-based organizations, public health and public housing agencies

DELIVERY SYSTEM IMPLICATIONS: the projected shortage of long term care workers is front-page news in the media and major business magazines ? AARP and aging network leaders all call for viewing older adults and Baby Boomers as a public asset, replacing the deficit view of older adults ? Research in the US and Great Britain confirms that Time Banking consistently attracts new volunteers, reduces volunteer burn-out attrition and generates added engagement by those already volunteering ? health care disparities are reduced when Time Banking bridges ethnic, age and class barriers, reaching undocumented workers and persons who tend to avoid involvement in formal systems ? neither public nor philanthropic funding can meet the vast need for informal support that CareShares can supply

POLICY IMPLICATIONS: Public policy needs to find ways to value and support the vast capacity of seniors to give and to sustain the informal system that currently supplies over $242 billion of unpaid care for seniors ? CareShares enlists the “consumer” of care as the co-producer of the outcome ? The outcome is more than informal support to address a disability ? Careshares makes visible the invisible economy of household, family, neighborhood and community by building a new form of extended family when the traditional family is no longer a reliable support system ? As a disruptive innovation, CareShares empowers and rewards the consumer for undertaking the individual and collective action needed to sustain health, to pursue meaning and purpose in life and to promote contribution that transcends market values.

Why do you emphasize franchising as opposed to integration with public health and welfare systems?
1. Public health and welfare systems focus on need and deficiency. CareShares consciously starts from an asset-based perspective.
2. Public health and welfare systems are designed to address problems when the social costs rise to sufficient level to imperil some public good. CareShares, like Time Banking, seeks to create health by building informal social networks.
3. Public health and welfare systems create “instrumental” social networks; people join them to get what they need, then leave them. Time Banking and CareShares seeks to develop “transformative social networks” where the human relationships are more important than the incentive. Those social networks remain, have multi-generational impact, and generate real system change.
4. Public health and welfare systems mean that the professionals own the problem, own the expertise, own the resource and dictate the relevant interventions. John McKnight calls them systems in need of need. Time Banking and CareShares build social capital and empower every individual to define himself or herself as a contributor and a decision maker.
5. CareShares and TimeBanking seek to rebuild the core economy of household, neighborhood and community – an economic system that functions on interdependence, that taps the abundance of capacity in community and that undergirds all public systems. One exception is the Alameda County Public Health Department that has formally embraced Time Banking and invested in its use to reduce violence and bring together the African-American and Hispanic communities.

If Time Banking has already been so successful, what has been the main challenges in it not yet having gained mainstream currency?

The main challenges are:
1. In the United States, enlisting the client community as co-producer of outcomes has not yet been formally embraced as a matter of public policy and professional practice. In Great Britain, that is now changing radically – but the awakening is only beginning to happen in this country.
2. Most economists still do not recognize the economic significance of the Core Economy of family, neighborhood and community. Because of the pervasiveness of chronic health conditions and its resistance to traditional methods, health professionals are now beginning to appreciate the importance and centrality of personal efficacy and mutual support.
3. The non-profit world struggles for survival and growth. It receives funding for service delivery but, until professional practice changes, payment for service delivery will not be used to cover the cost of enlisting the consumer as partner and co-producer. Time Banking costs money - for the infrastructure that enlists the client community.

Can we see more evidence of Time Banking’s efficacy.
Time Banking was first tested at six sites by a $1.2 million dollar, three year initiative funded by the Robert Wood Johnson Foundation to determine whether Time Banking (originally called service credits) could enhance the chances of frail seniors remaining in community by enlisting the well elderly to provide informal support services and respite for caregivers. The most in-depth study of service credit programs was conducted under contract with the Robert Wood Johnson Foundation by the Center For Health Policy Studies of Georgetown University. A summary of its findings concluded:

"Programs can indeed attract elders in return for service credits. Although the services provided are not, for the most part, the hands-on personal care needed by the most impaired, evidence indicates they are services necessary to the independent functioning of an older, frailer population with potentially limited social supports....Although sites have had to address issues of credit management, the primary management task they have faced has been how to attract, support, and sustain their volunteers.

The evaluation notes:

"...[Service credit program] sites have tended to emphasize the establishment of relationships among participants--building a sense of community--over formal rules for banking or service exchange. As a result, programs have developed less as anonymous or mechanical exchanges than as community membership organizations."1

Recognition of its significance and effectiveness has grown steadily.

Elderplan, a health maintenance organization that was one of the original pilot programs funded by the Robert Wood Johnson Foundation. In 1997, its Time Banking program was listed as one of the top 20 ways to save the world in U.S. News and World Report. Since then, it has received 1999 Points of Light President’s Service Award; the American Society on Aging’s 1999 Managed Care and Aging: Recognizing Innovation and Quality Award; Honorable Mention for the Archstone Foundation Award for Excellence in Program Innovation, awarded by the Gerontological Health Section of the American Public Health Association.
A multi-year, in-depth evaluation funded by the Fan Fox & Samuels Foundation found that Time Banking had a significant impact on mental health, reduction in need for medication, on membership retention, and continuity of care. Prior to that, Elderplan had reported instances where hospital discharge had been made possible and nursing home institutionalized care avoided or (in other cases) delayed by months as a result of the Time Bank program.

Recognition of the significance of Time Banking has emerged on many fronts. The U.S. Administration on Aging designated Partners in Care as an exemplary program delivering transportation to the elderly. For ten years, Partners in Care has utilized Time Banking to provide an array of informal support services to a membership that now exceeds 1,800 in Anne Arundel County, Maryland. Moreover, senior Time Bank members provide the staffing to run an upscale Thrift Shop that generates in excess of $35,000 annually. That covers a substantial portion of the operating costs of Partners in Care.

The Annie E. Casey Foundation has awarded its top honor, the Family Service Award of $500,000 to two organizations, Abriendo Puertas (Miami) and Grace Hill (St. Louis) citing its Time Bank program as a basis of the award.

In Great Britain, the Secretary of Health has specifically designated Time Banks as the vehicle for providing essential informal care with the formal care system provided by the National Health Service. The Green Paper issued by the government notes:
“One example of a creative solution to matching individual needs for support and the willingness of others to volunteer is in the use of Time Banks and we would like to se a greater exploration of their potential to contribute to local capcity building.”

The Department of Health of the United Kingdom then funded an initiative that partnered Time Banks UK with Help the Aged in order to promoted timebanking across the United Kingdom. This was done in part because of the distinctive success of Time Banking in reaching and involving the elderly and persons living with long-term illiness or disability (42% of timebank members are retired compared with 19% of volunteers for charities; 20% of time bank members earn time credis as members of timebanks compared with 3% of volunteers for charities.)

Time Banking has now spread to 23 countries. (Australia, Canada, Curacao, Denmark, Dominican Republic, England, Ghana, Holland, India, Israel, Italy, Japan, Mexico, New Zealand, Norway, Portugal, Scotland, Senegal, Slovakia, South Korea, Spain, United States, and Wales).

Originally, Time Banking was promoted by foundations and governments because of its manifest potential for addressing the needs of the frail elderly. This perspective has shifted as the potential of Time Banking emerged as a vehicle to tap the vast capacity of seniors to contribute, to transmit core values, to play new leadership roles in rebuilding community and to create and staff new ventures.

That dimension of Time Banking has attained major implications as the concept of Co-Production developed by Time Banks USA has gained international attention. A three year study of Co-Production released in June 2006 by the Roundtree Foundation in Great Britain defines co-production as a “general description of the process whereby clients work alongside professionals as partnersin the delivery of services.” The findings noted:
? There is an emerging ‘co-production’ sector - both inside and outside public services - where service users are regarded as assets, involved in mutual support and the delivery of services.
? A key characteristic of public and voluntary institutions that successfully involve their users, as well as their families and neighbours, is an understanding that people who have previously been treated as collective burdens on an overstretched systems are untapped potential assets.
? Some kind of reciprocal relationships between users and organizations can broaden the social reach of the projects: ‘time banks’ are an effective - though not the only way – way of valuing their contribution.

Attached are a series of studies from the United States and Great Britain
a. Dr. Gill Seyfang, Research Findings About Time Banks in the UK; Growing Healthy Communities One Favour At A Time: Evaluating time banks as a new tool for tackling social exclusion
b. Susan Jones, The Impact of Clapham Park TimeBank on Mental Well-Being
c. Susan Jones & Vanessa Gould, Evaluation of the Consortium using the Mental Health & Wellbeing Impact Assessment
d. Elderplan, An Evaluation of ElderPlan’s Time Dollar Model
e. Socio-medical Research Group, Department of Social Psychiatry, St Thomas Hospital Campus Can Time Banks Deliver? Evaluation of the Time Bank at Rushey Green Surgery
f. Department of Sociology and Anthropology, Lehigh University; Abby Letcher, Anne Rogers, Lehigh Valley Hospital, Building Community Ties and Individual Well Being: A Case Study of the Community Exchange Organization
g. Letters of Support by Representatives of Major National Organizations that know the work of TimeBanks USA: National Legal Aid and Defender Association, National Community Action Foundation, World Vision Appalachia, Director, Volunteer Alliances, AARP, Youth Advocate Program.

If it is already mainstream, then what is the new innovation. See above

Is your organization already at the state of not needing further seed funding?

No. Our core budget (excluding the Time Dollar Youth Court) supports only four staff and a contract with two programmers. A philanthropist’s commitment of three years funding ends this year; nearly 2/5th have been spent developing the new web-based software and forums.

We have just completed a year’s strategic planning, a Board restructuring and the development of a business plan for CareShares. A vibrant membership organization is emerging. We have developed train-the-trainers capacity, a start-up kit, videos, a Grassroots Fundraising Sourcebook, newsletters, a set of partnerships with national organizations, a meta-TimeBank of TimeBanks to function as a learning organization and a business plan for Careshares. An international Time Banking Congress co-sponsored by the University of Wisconsin and the Dane County Time Bank will be held on November 1-3, 2007. We are now at the point where seed funding can enable us to utilize CareShares to take Time Banking to scale.

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