TimeBanking with CareShares: Consumers as Co-Producers of Health and Long Term Care
CareShares radically increases the supply of help, makes eldercare affordable and restructures the current health support system by turning consumers, users and their families into providers of basic services. Participation lowers price by enabling members to pay for care with time credits. Other family members can co-pay by contributions of time or money. No insurance plan covers watering plants, taking care of pets when one goes into hospital - or doing the laundry and shopping when one returns. Yet, friendly informal support and reminders after a hospital stay provided by Time Bank members has been proven to sharply reduce rehospitalization. Being able to "give back" and contribute by helping others has been shown to positively impact mental health.
By unbundling the services that can be provided by non-credentialed personnel from those services that must be provided by certified health aides, CareShares lowers members' costs for help, and enables members to earn the help they want when they need it. With matchmaking by the local CareShares coordinator, members gain support for handling problems while they are small, reducing need for formal care. By pooling risk they can expand the volume of services and lower costs per user.
Unbundling also opens the provider field. Organizations such as senior centers, faith-based organizations, and community-based organizations will be encouraged to become CareShares site hosts or sponsors. Insurance costs for liability drop if providers are volunteers rather than commercial home care providers. By offering the chance to earn back-up help for unpredictable times of need CareShares encourages Baby Boomers with elder parents to volunteer for the host and sponsoring organizations. Seniors needing occasional care find they are valued providers of companionship and mentoring. Barriers to help from lack of knowledge, language, ethnicity and inhibitions about asking are reduced by a call to the CareShare coordinator.
About You
Location
Project Street Address
Project City
Project Province/State
Project Postal/Zip Code
Project Country
Your idea
Focus of activity
Service/process
Year the initiative began (yyyy)
1987
Positioning of your initiative on the mosaic diagram
Which of these barriers is the primary focus of your work?
Patients not empowered
Which of the principles is the primary focus of your work?
Push work down the chain of command
If you believe some other barrier or principle should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic:
The matrix for disruptive innovation treats health as a commodity and patients as consumers. These are constraints. Our "disruptive innovation" is based on different premises:
1. Social networks, relationships and informal support systems are essential to health. Connectedness and love are needs that a purely commercial market cannot meet. Disruption involves going beyond commodification that turns health care into treatment for illness.
2. Elders need to be valued for what they can offer. A deficit-centered model of health care is necessarily disempowering.
3. Patient empowerment goes beyond their role of consumers. Disruptive empowerment entails enlisting patients as co-producers of health. That impacts price, quality, accessibility, loyalty, utilization. Product and process change.
Name Your Project
TimeBanking with CareShares: Consumers as Co-Producers of Health and Long Term Care
Describe Your Idea
CareShares radically increases the supply of help, makes eldercare affordable and restructures the current health support system by turning consumers, users and their families into providers of basic services. Participation lowers price by enabling members to pay for care with time credits. Other family members can co-pay by contributions of time or money. No insurance plan covers watering plants, taking care of pets when one goes into hospital - or doing the laundry and shopping when one returns. Yet, friendly informal support and reminders after a hospital stay provided by Time Bank members has been proven to sharply reduce rehospitalization. Being able to "give back" and contribute by helping others has been shown to positively impact mental health.
By unbundling the services that can be provided by non-credentialed personnel from those services that must be provided by certified health aides, CareShares lowers members' costs for help, and enables members to earn the help they want when they need it. With matchmaking by the local CareShares coordinator, members gain support for handling problems while they are small, reducing need for formal care. By pooling risk they can expand the volume of services and lower costs per user.
Unbundling also opens the provider field. Organizations such as senior centers, faith-based organizations, and community-based organizations will be encouraged to become CareShares site hosts or sponsors. Insurance costs for liability drop if providers are volunteers rather than commercial home care providers. By offering the chance to earn back-up help for unpredictable times of need CareShares encourages Baby Boomers with elder parents to volunteer for the host and sponsoring organizations. Seniors needing occasional care find they are valued providers of companionship and mentoring. Barriers to help from lack of knowledge, language, ethnicity and inhibitions about asking are reduced by a call to the CareShare coordinator.
Innovation
Define the innovation
CareShares radically increases the supply of help, makes eldercare affordable and restructures the current health support system by turning consumers, users and their families into providers of basic services. Participation lowers price by enabling members to pay for care with time credits. Other family members can co-pay by contributions of time or money. No insurance plan covers watering plants, taking care of pets when one goes into hospital - or doing the laundry and shopping when one returns. Yet, friendly informal support and reminders after a hospital stay provided by Time Bank members has been proven to sharply reduce rehospitalization. Being able to "give back" and contribute by helping others has been shown to positively impact mental health.
By unbundling the services that can be provided by non-credentialed personnel from those services that must be provided by certified health aides, CareShares lowers members' costs for help, and enables members to earn the help they want when they need it. With matchmaking by the local CareShares coordinator, members gain support for handling problems while they are small, reducing need for formal care. By pooling risk they can expand the volume of services and lower costs per user.
Unbundling also opens the provider field. Organizations such as senior centers, faith-based organizations, and community-based organizations will be encouraged to become CareShares site hosts or sponsors. Insurance costs for liability drop if providers are volunteers rather than commercial home care providers. By offering the chance to earn back-up help for unpredictable times of need CareShares encourages Baby Boomers with elder parents to volunteer for the host and sponsoring organizations. Seniors needing occasional care find they are valued providers of companionship and mentoring. Barriers to help from lack of knowledge, language, ethnicity and inhibitions about asking are reduced by a call to the CareShare coordinator.
Context for Disruption:
Baby Boomers, their parents, and caregivers need an affordable, reliable informal support system. Changing a light-bulb or doing grocery shopping following hospitalization can prevent small problems from escalating into major life crises. Extended family and neighbors once provided that support. But Americans' support networks are shrinking. Increasingly, the only options are limited public care or costly paid help. A low-cost, effective analog of extended family can impact millions.
Enter CareShares, repackaging Time Banking as a social venture enterprise. In Time Banking, local Time Bank members earn a tax-exempt time credit for each hour helping others. They can use those to get help for themselves or others. Those receiving help offer what they can to others. New web-based software stores members' information, enables members to connect with each other and keeps track of credits earned and spent. A paid coordinator oversees background checks, schedules social events, and assures personal help and outreach to newcomers and to those not computer literate. Harnessing age-old principles of mutual support and reciprocity, Time Banking delivers "labor with love," embeds members in networks of support, and rebuilds community.
Repackaged as a social venture, CareShares supplies the revenue needed to take Time Banking to scale. Monthly premiums in money and time credits (earned by helping others) provide both the revenue and caring labor needed for long term sustainability. Members earn time credits providing care or by assisting local non-profits that agree to reciprocate with service or resources for CareShare members. Dollar payments pay the coordinator and build reserves to purchase back-up care when needed. Families can share both costs and benefits. CareShares builds on the proven efficacy of Time Banking. The social venture element supplies sustainability, reliability and civic engagement to cope with the Age Wave tsunami.
Delivery Model
As a start-up social venture, CareShares has zero market penetration but draws on 20 years of successful experience with Time Banking, incorporates that approach, rides on its reputation, website, networks and name recognition. CareShares makes its services available to its members. Monthly premiums that pay the CareShares coordinator and support the CareShares program are new features. In return, members receive a "best faith effort" guarantee of help when they need it from Time Bank members or from a back-up source of paid help if help is not available from members. The CareShares coordinator helps members put data into the Community Weaver web-based software. Members can use the software to arrange for help with other members directly, or can call the coordinator to do it for them. Members will have to build up a number of premium credits before they can access the help they need, with an upper limit of time per month. Families who join to pool the risk and the benefits will have the same level of premiums and benefits as individuals.
At the national level, CareShares will operate as a quasi-franchise, charging a licensing fee for each CareShares program. In return, CaresShares programs will receive training for the coordinator and access to the supported web-based software that supports CareShares programs. They will also receive collateral outreach and membership materials, and access to collaborative exchanges of information through web-based forums and e-bulletins for CareShares program affiliates.
Public or non-profit organizations will host or sponsor CareShares as a way to lower costs and expand services for the older adults they serve. Initial outreach efforts confirm that CareShares fills a critical need in a way that assures widespread adoption.
Key Operational Partnerships
Formal partnerships with national organizations and board members provide ample networks for identifying potential sites. These include: Robert Egger organizer, the Non-Profit Congress; Badi Foster, CEO, Phelps Stokes Fund; Arnold Perkins, former Director, Alameda County Department of Public Health; Richard Rockefeller, Chairman, Rockefeller Bros Foundation; Tom Jones, former Director of Strategic Alliances, World Vision.
Key persons in elder services provide access to a broad range of expertise. (e.g. Andrea Sherman, Director, Consortium of New York Geriatric Education Centers; Andrea Cohen, founder, HouseWorks and pioneer in eldercare business development).
Time Banking is highly respected by the Corporation for National and Community Service. The Annie Casey Foundation has invested in TimeBanks USA for ten years. U.S. Assistant Secretary for Aging, Josefina Carbonell previously headed one of the most successful original Time Banks. A new TimeBank of TimeBanks provides a decentralized distributive system that enhances outreach and accelerates shared learning and collaboration. Local TimeBanks have developed close working relationships with municipal, metropolitan, state, regional and national organizations. A 20 year track record of performance and innovation based on shared values, fiscal discipline, and mission has earned Points of Light, designation as exemplary programs and awards that provide a foundation for next steps.
Impact
Financial Model
The fiscal model for our innovation assumes that start-up capital of at least $274,000 will be needed by TimeBanks USA for the first 3-5 years. Start-up funding will cover staffing and consultants to provide training, monitoring, web-site and data management, evaluation, legal counsel, outreach, marketing, government relations and seed money for pilots. TimeBanks USA will break even when it has mounted 300 programs of varying sizes with annual franchise fees ranging from $1,500 for small sites to $3,500 to $5,000 for multi-site franchises.
We have designed CareShares to offer a choice between two sets of premiums.
Option 1. $5 per week and 4 Time Dollars per month.
Option 2. $2 per week and 8 Time Dollars per month
That choice enables families to share the burden and makes CareShares widely affordable.
If 50% choose option 1 and 50% choose option 2, then look at what happens.
With 150 members, that mix generates annually $27,300 and 10,800 Time Dollars.
With 300 members, that mix generates annually $54,600 and 21,600 Time Dollars.
Each pilot will break even when it reaches between 200-300 members even without supplemental funding from philanthropic and public sources. Expenses to operate a local CareShare program will vary enormously depending upon site. A senior center that provides luncheons and has a core of volunteers or a Naturally Occurring Retirement Community will be able to host a CareShares program with one staff person supplemented by ongoing support systems already in place.
What is your annual operating budget?
$1 m
What are your current sources of revenue? (please list any sources that are foundation grants)
Foundation grant (Annie E. Casey Foundation, Rudolf Steiner Fund, Threshold Foundation), government grants, individual donors, contract income, membership dues, material fees
Effectiveness
There are at least 80 Time Banks in the US. Time Banks UK reports 86 operating Time Banks and 39 under development. Since 1987, they have generated millions of hours of help. An evaluation from the UK reports that "Time Banks are successfully attracting participants from social excluded groups, in attracting people who would not normally get involved in traditional volunteering."
In Spain, Portugal and Italy, the women's movement has been organizing Time Banks. The Annie E. Casey Foundation has launched Time Banks in its Making Connection sites to build vibrant neighborhoods. In Massachusetts, New York, Washington, and Rhode Island, Time Banks are being used to deliver support to families with special needs children and to enlist those families and children as contributors. In Oakland, it is being used to reduce violence and bridge relations between Black and Hispanic communities. A social HMO in New York has confirmed the impact of Time Banking on social isolation and mental health of the elderly. The Time Dollar Youth Court in DC where teen jurors earn Time Dollars, has reduced recidivism by over 50%. The Visiting Nurse Service of New York has just launched the first of a citywide network of Time Banks to bring health into under-served communities. In Allentown, a hospital has integrated Time Banking into its discharge plans and its care for patients with chronic disease. World Vision uses Time Banking to fight poverty in Appalachia
Which element of the program proved itself most effective?
Time Banking values the work it takes to build families, strengthen social networks, promote civic engagement. A Time Bank statement validates time spent building an economic system that values caring and decency as core values. Its most dramatic effect is turning (helping( from a one way transaction to a relationship based on respect because the person receiving help can pay back in the currency of time.
The design of the currency is probably the element that makes Time Banking effective.
Each characteristic of a currency sets certain dynamics in motion. Time Banking changed the characteristics of money in ways that make it possible to do things money cannot do. A medium of excchange drives an information system that matches supply to demand, capacity to need. Time credits tap a vast untapped reserved: abilities and people that the market and money do not value. A key feature of money is price. In Time Banking, all hours are valued equally. If scarcity determines price and price defines value, then every universal capacity that enables our species to surive and evolve is worthless. The elimination of price enables time Banking to value what it means to be human. A currency that records and validates acts of caring and decency empowers evryone to be recognized and valued as a contributor.
Number of clients in the last year?
We have "members," not clients. The terminology reflects core values that regard every human being as a potential contributor, enlists "clients" as co-producers of outcomes and knits individuals together in an extended family.
Estimates of present Time Bank memberships in 23 countries range from 150,000 to 200,000 and beyond. The primary factor limiting expansion has been the cost of the staff and infrastructure needed to knit strangers and neighbors together into a new kind of extended family. Information technology has radically reduced the transaction costs. A philanthropist has invested nearly a half million dollars creating Community Weaver to tap the potential of the web. But the coordinator or match-maker is an essential catalyst, building trust and creating a new social etiquette that makes it possible to ask for help because one is going to pay back. Personal contact and social events are key lubricants.
Though Time Banking is well established, CareShares is new. It has been designed to realize a breakthrough - making vast amounts of reliable, trustworthy informal care affordable by combining two currencies: time and money.
What is the potential demand?
CareShares is a social enterprise that seeks to deliver the kind of informal care that family, kinfolk and neighbors have traditionally given. Gerontologists distinguish between services designed to address disabilities involving Activities of Daily Living ( ADL) (e.g. bathing, toileting, medication) and those involving Instrumental Activities of Daily Living (IADL) (e.g. housekeeping, shopping, transportation, bill paying, meal preparation. ) Time Banking has proven particularly effective in providing services where the disability involves IADL.
A report by the Department of Health and Human Services and the Department of Labor projects the scale of the demand for CareShares:
"Informal care givers provide the majority of long-term care services in the U.S. In 2000, there were 22 million unpaid informal care givers aiding elderly persons in the U.S. The number of informal care givers will rise in 2000 from approximately 22 million individuals caring for approximately 14 million elderly Americans, to approximately 40 million individuals caring for approximately 28 million Americans in 2050.
"Baby boomers are likely to rely even more on spouses because husbands and wives are both living longer, and the longevity gap between them is narrowing. However, lower rates of marriage and higher rates of divorce are the distinguishing marital characteristics of this generation, resulting in more baby boomers moving into middle and older ages without a spouse to help with potential care needs.
"Elderly baby boomers will have fewer adult children available to provide informal care. This can be attributed to their fertility rate also being lower than that of their parents, and the fact that baby boomers are somewhat more likely than earlier generations to be childless. Where there are children, they may be more likely to seek assistance from paid care givers because they will have fewer siblings with whom to share caregiving responsibilities."
Scaling up Strategy
Our priority for the next years is to prove that CareShare franchises are self-sustaining, to demonstrate their effectiveness in meeting a critical national need and to generate a sufficient number of CareShare franchises to support the national CareShares division of TimeBanks USA paying an annual fee and renewing the franchise.
Funding proposals are being prepared for at least three pilots the first year, six more the second year and six to ten more in year three. TimeBanks USA will expand and make use of a refined communications system to track developments and provide coaching and assistance as needed. The meta TimeBank-of-TimeBanks will be used to share learning, pool knowledge, modify the model and understand differences that arise in different locales and different populations. A formal advisory board will be established in the first year. We have identified an initial pool of consultants and a range of potential partners.
After launching the first pilots, we will explore citywide and state expansion. We have already received positive signals from New Mexico, New Hampshire and Massachusetts. Prospects for support include the Corporation for National and Community Service, the U.S. Administration on Aging, state agencies and insurance companies.
We seek first to realize certain outcome measures in the pilots: Provide 80 percent of CareShare members over age 65 with assistance that helps them remain in their own homes. Support the health and vitality of older CareShare members by enabling them to serve others at least twice a month. Save at least 80 percent of CareShare members an amount equal to or greater than the cost of their membership (e.g. taxi services, home maintenance, and meal services following a hospitalization) Enable at least 80 percent of CareShare members to form one or more new relationships with another CareShare member or community member as a result of their participation.
Stage of the initiative:
0
Expansion plan:
Achieving these outcomes will involve launching pilots collaboratively, building our staff infrastructure, creating a brand/identity package, developing a program licensing package, identifying initial local partners, creating or adapting program materials, refining the software, developing bi-lingual screens and materials, recruiting a national advisory board, securing testimonials and individual stories, identifying and pursuing funding sources, holding an annual conference, commissioning and completing evaluations, refining the franchise model, initiating a marketing campaign, recruiting additional local partners, securing media coverage, developing proposals for legislatures at the local, state and federal level.
Our objective is to demonstrate the power of CareShares to enable older adults to age in p lace and to be a major force in building strong communities. To do so, we will need to continuously refine the program model, and develop the infrastructure needed to expand and support enough sites to enable the national office to continue to function as a catalyst for innovation.
The Massachusetts Institute of Technology Enterprise Forum has provided a critique of the initial business plan and offered to provide ongoing technical assistance as the initiative develops. Similar expertise has been proffered in discussions with the AARP, the National Council on Aging, and various university Departments of Social Work and Gerontology.
Origin of the Initiative
In 1980, Edgar Cahn, founder of Time Banking, had a major heart attack at age 44. Lying in the hospital bed being cared for by a legion of professionals, he asked himself: "Why am I not enjoying all this care? " His answer was: "For me, being truly alive is making a difference in the lives of others. I don't like being useless."
In 1980, millions were "useless": old, young, unemployed, disabled, persons on public assistance. Cahn asked: "Is there some way we can begin putting people and problems together?" With the government cutting back on social programs, Cahn's answer was a new kind of money to ensure that no one willing to help others would be "useless." His work at the London School of Economics proved that theoretically possible. In 1987, a $1.2 million initiative by the Robert Wood Johnson Foundation launched Time Banking. Now 72, Cahn credits his recovery to Time Banking.
This Entry is about (Issues)
Sustainability
What are your two main challenges to finance the growth of your initiative
1. Funding to create social networks or informal care does not seem like a priority. Professionals do not assign importance to what non-professionals can do. While everyone says that citizen engagement is critical, they tend to classify that as "volunteering" and not as real work that requires systems, incentives and rewards. Informal care is a low priority for health care - because medicine is still primarily about disease, specialization and treatment.
2. Investing in creating a new kind of money seems contradictory. If it is new kind of money, why can't it create itself ? There is little understanding of what it takes to create a banking infrastructure that can enlist untapped capacity to meet unmet need. The core economy of family, neighborhood, civil society is not part of the economic map so that revitalizing it is not reflected in the GDP or conventional economic measures.
Experts in business development told us that TimeBanksUSA would need $273,000 the first year and $600,000 the second year to scale up. By year 3 or 4, if we fielded sufficient pilots, that would level off. They predicted we would not break even until 300 CareShare franchises were operating.
How did you hear about this contest and what is your main incentive to participate?
An e-mail from ChangeMakers. Developing CareShares to take Time Banking to scale had been underway for a year. The Robert Wood Johnson Foundation had been the original funder. By coincidence, we had just read "The Innovator's Solution." This seemed like a natural match.
The Story
Do you have an annual financial statement?
Yes and Yes. We ended last year in the black and are on target for FY 2007
Do you currently have an annual financial statement that tracks profit/loss?
Year 1 $274,000 (Staff $123, 750; Consultants $70,000; Indirect $35,000; and Program Seed Grants of $45,000)
We anticipate enabling pilot programs to grow by helping them secure initial grant funding at the same time that our own staff capacity grows. By year 5, we will need approximately $400,000. Our business consultants have projected a budget of $710,000 but they predict that will be substantially offset by revenues from licensing fees ranging from $1,500 to $5,000 and by corporate and government funding. When we have licensed 300 local CareShares partners they are projecting approximately $775,000 in licensing fees which will make CareShares self-sustaining on the national level as well as on the local, franchise level.
Please describe the amount (and/or type) of funding you need to implement your initiative, at year 1 and at year 5.
