The Periodic Table of Technology-Supported Ageing prioritizes “Self” as the central character. Yet the individual represented is surrounded and supported by a dynamic network of others that may change over time. Understanding these secondary and tertiary players, what they do, how they contribute and what they represent to “Self” is critical to the definition of a solution — whether these roles are direct or indirect participants in that solution.
We identified four main categories of user and roles based on the proximity to the individual, or Self. They are: Family, Friends and/or Neighbors, Service Providers and Policy Makers.
Family is likely to be closest and most actively involved in the life concerns of “Self”. Family members are typically the first to be called upon in case of need and generally expected to be accessible by phone or in person without boundaries of time of day or day of week. There is context for family that does not often exist for others. They are part of the Self’s history and culture and often are deeply knowledgeable about life details such as health status, location, activities, habits, concerns, and other factors that shape the life and behavior of Self.
A recent AARP study, “Family Caregiving and Out-of-Pocket Costs: 2016 Report”, tells us that the informal caregiving role often played by US family members is made up of nearly 40 million Americans who contribute between $7000 – $12,000 per year in unreimbursed expenses. And it is a global issue. Italy, a country on the leading edge of the ageing trend counts more than one million informal family caregivers. However, in this country of 60 million citizens, families also spend 7B Euro per year outsourcing care to almost a million semi-skilled private workers, or ‘badanti’. A number that is up by 42% in just the last 8 years according to Dr. Paolo Mizzola.
As caregivers themselves age and birth rates continue to fall in developed nations, the ratio of potential family caregivers to those over 80 will be squeezed. A January 2017 New York Times article contributed by Dr. Dhruv Khullar points to a decline of more than half from 2015 to 2050 when seven potential caregivers to each elder becomes only three to one.
Societal expectations generally include that of family members playing a primary role in support of elders and often inversely includes the notion of elders caring for grandchildren. This generational interdependence might even be something of the definition of family. However, when taken with demographic shifts, smaller follow-on generations mean a traditional family construct that once supported elders must also morph and is in part the reason for inclusion of various other support roles in the Periodic Table for Technology-supported Ageing.
Friends and/or Neighbors represent another set of roles that encompass close relationship or geographic proximity especially important in absence of familial support. Urban migration is a factor that impacts elder support in many countries as younger generations leave traditional family localities in search of employment, education, or other pursuits. Structured or unstructured networks of friends and helpers – whether consistently or only infrequently engaged – may act as “proximity Angels”. Their role can cover a wide spectrum; from emergency response, to support for daily chores, to simply social companionship. Programs such as LinkAges in the San Francisco Bay Area, and Beacon Hill Village in Boston, serve as excellent examples of the opportunities to forge meaningful support networks beyond traditional families. Other examples from around the world can be found in the WHO Global Network for Age-friendly Cities and Communities.
Service Providers can range from paid caregivers, to healthcare systems, public emergency response, direct government programs, or NGOs, and are frequently called upon to fill the widening void of unpaid family caregivers. Service Providers sometimes even serve as the connective tissue between an elder and the world beyond their garden gate. For the purpose of the Periodic Table, “Service Providers” can be residential such as independent living, assisted living, skilled nursing or rehab facilities. They may also be services provided at home ranging from meal delivery to memory care, hospice to home health, assistance with activities of daily living, or perhaps home retrofitters. New to the scene are technology, transportation, retailers and home delivery services through sometimes unexpected channels such as telcos, insurance companies, or postal services.
Among our favorite examples is Jersey Post, on the British Channel Island of Jersey, which offers a “Call and Check” service to seniors across the island. This simple and affordable service allows seniors to feel they have a conduit and trusted resource to do everything from fetching a prescription to relaying a message to doctors. They also serve an important observational role in assessment of status of the subscribed elder, helping to identify otherwise unnoticed physical or cognitive decline is given proper attention, or that risks and hazards around the home are attended. Belgium, France, Japan, and Italy have or are experimenting with similar models, some supported with technology, others quite manual.
Policy Makers play a vital role in defining, chartering, funding or otherwise enabling systems of support for older populations. It is vital to consider the range of needs across a spectrum of age-related matters to truly assure Policy Makers are considered in an approach to a solution. National, regional and local public policy makers are concerned with broad populations on issues from employment policy to service qualification and definition. Some third-sector organizations are among the greatest sources of policy development and agenda because they provide deepest grasp of the broad or narrow topics in their charter.
The European Union sets a good example having funded several projects over the last 20 years with the Active and Healthy Ageing initiative. Or AARP a leading advocacy organization in the United States, studies issues of ageing across their 37M over-50-year-old members. This enables them to model current and project future needs for policy development by public and private entities– not just in the US, but as trends for global consideration.
National, regional and municipal governments carry the largest burden for policy development and implementation even as the rely on others to help inform them.
The important work of policy makers is the foundation for anticipating or responding to changing needs and should be considered when contemplating the application of technology to address societal objectives. Reduction of cost and utilization burden on health systems, expansion of employment options post-retirement, direct monetary benefit schemes, are examples of where policy makers have focused work. New concerns in areas of financial fraud and abuse, risk determinations of rapidly increasing populations citizens over 100 years old are now in the line of sight, while security and privacy remain issues for organizations.
We observe increasing numbers of technology-based solutions for ageing based on interactions between “Self” and others. Many start with “Service Providers” as the primary beneficiary of the technology, perhaps allowing “Self” or “Family” a means of interacting through that technology. Successfully supporting the full spectrum of ageing needs is likeliest when involvement, communication, sharing of information and data is mutual, transparent and designed around the tenets suggested in the Periodic Table. Families can benefit directly from technologies or services useful to their support role and location, and indirectly when Self’s care needs are reduced. We believe the concept of a single caregiver is limiting. We prefer to envision an orchestration between actors with different roles, involvement and responsibilities which will evolve around an individual and his/her ageing journey.
A well-designed solution involves various actors in the design and development process to ensure the alignment of interests that removes friction and promotes adoption regardless of role. Considering that a single individual may be simultaneously a caregiver and a care recipient, as is the case with many older couples remaining in their family homes, remember to incorporate multiple views on what a ‘role’ may encompass. Likewise, considering the depth of users behind a “Service Provider” is also essential. Behind the curtain, services are provided by nurses, social workers, physical therapists and others, all with their own lives, professionals challenges, financial, and day-to-day stresses. Understand how they are motivated and how they benefit from the solution you design and adoption is simplified.
In light of a changing world, the African proverb routinely used to describe child-rearing – “it takes a village…” – could be a mantra best applied to looking after society’s elders. It certainly requires many finely-tuned roles surrounding each individual to support ageing populations of today and tomorrow.
Please also read:
Part 1: Building a common language: why we need a periodic table for technology-supported ageing
Part 2: Building a common language for technology-supported ageing: why we started with “Self”
Part 3: Building a common language for technology-supported ageing: The Tenets
Also, download the latest IBM Institute of Business Value executive report: “Loneliness and the ageing population: How businesses and governments can address a looming crisis”.