Natural care: it's in our nature

Taking Care - It’s in our Nature

Al Etmanski - Partner, Social Innovation Generation; Co-Founder PLAN; Chair, BC Advisory Council Social Entrepreneurship

December 7th, 2011

Tyze  creates  private,    secure,  online  networks  that    

coordinate  care  and    contribute  to  improved  outcomes  

 and  cost  efficiencies.  

Taking Care Is

… a fact of everyday life, for everyone. Either as family, friends, neighbours, co-workers, members of networks or community we take care of our children; people with chronic illness, disability or mental illness; people with health challenges; people down on their luck; people in crisis or the victim of a catastrophe; and people who are ageing and infirm and their caregivers.

Natural freely given care is the backbone of our society.

from Taking Care - BC’s Advisory Council on Social Entrepreneurship

http://socialinnovationbc.ca/about/

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Taking Care Is

…heart work, accompanied by joy, grace, and tenderness. It can also be messy, unyielding, unromantic and decidedly unglamorous. It is given to people we love and care about, who are or have become dependent on us for many basic needs. This includes caring for our babies, our loved ones who are elderly, who have chronic illness, mental illness or disabilities, and for each other.

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80/20 Proposition

• The four million family caregivers of ailing parents and relatives with severe disabilities provide more than 80 per cent of care in this country. Most are women - and we face unique pressures. (Sherri Torjman)

• Professional service provision is also dependent on natural freely given care. Most (80%) who receive paid in home care still rely on friends and family for most of their care and sense of belonging.

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It’s in our Nature

Unpaid family caregiving has become a key component of Canada’s publicly-funded health and social care system. As our population continues to age, more and more British Columbians will find themselves caring for parents, grandparents and other older adults. Many caregivers will join the ‘sandwich generation’, who provide care simultaneously for both young children and parents. Home care could not exist in Canada without the support of informal networks and caregivers.

BC Law Institute/Canadian Centre for Elder Law

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It’s in our Nature

•  2.7 Million (8% of Canada's population) provide care to their aging relatives

•  Up to 90% of eldercare is delivered by families

•  500,000 Canadians care for an adult relative with mental illness

•  28% of Canadians provide health care assistance to a family member or friend

•  in total there are 4 million family and friends providing care in Canada

•  the majority of caregivers are women

•  70% of caregivers are employed

•  care provided by friends to friends ranks second only to people caring for their mothers

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It’s in our Nature

… a reasonably conservative estimate of the imputed economic contribution of unpaid caregivers for Canada, for 2009, would be $25-$26 billion.

»  Marcus J. Hollander, Guiping Liu and Neena L. Chappell

»  www.longwoods.com/content/20660

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Challenges

• Natural care is under stress - loss of wages; job insecurity; limited respite; inflexible program criteria; limited recognition of extraordinary costs; few preventive resources; institutions and society that is not care friendly

• Budgets for institutional and professional caregiving are under stress. Government resources declining at a time of increased service demand

• Social isolation underpins homelessness, poverty, ageing, mental illness, disability, family caregiving, unemployment

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Stresses

There are more First Nations children in foster care today than were placed in Residential Schools at their height.

Cindy Blackstock - First Nations Caring Society

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Stresses

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More than one in four Canadian employees who are caregivers experience high levels of financial, physical and/or emotional stress that can affect their health, their effectiveness as a caregiver, and their labour force participation. Many caregivers quit their jobs, reduce their hours, experience high absenteeism and forfeit career ambitions and aspirations. Their income drops, their health suffers and their stress levels rise.

Vanier Institute of the Family

Stresses

Caregivers often pay for basics for care receivers, many of whom live in poverty. Caregivers typically pay for disability supports not covered by medicare or private insurance.

Sherri Torjman

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Four Thoughts on Next Steps

1.  Thinking and Acting like a Network

2.  Shifting Resources

3.  Coming Together

4.  Supporting Passionate Amateurs

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Premise

At a time when our formal, paid systems of health and social care are under stress, let’s make sure the backbone of natural care is strong,healthy and resilient.

Reform of health and social care systems and institutions must also take into consideration those who provide the bulk of care - families, friends, co-workers, network members, neighbours, volunteers

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1. Thinking and Acting Like a Network

• New Mindset - from individual focus to network centric approach to care

• Ethic of Care - an issue of justice, our survival and well being

• Giving and receiving care defines us as citizens

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Social Justice

Social factors have a powerful influence on human health and longevity. Yet the social dimensions of health are often obscured in public discussions due to the overwhelming focus in health policy on medical care, individual-level risk factor research, and changing individual behaviours. Likewise, in philosophical approaches to health and social justice, the debates have largely focused on rationing problems in health care and on personal responsibility. However, a range of events over the past two decades such as the study of modern famines, the global experience of HIV/AIDS, the international women’s health movement, and the flourishing of social epidemiological research have drawn attention to the robust relationship between health and broad social arrangements. Sridhar Venkatapuram - Health Justice

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From Individual to Network Centric

The  most  appropriate  care  system  for  an  aging  society  is  one  that  supports  both  caregivers  and  older  adults  in  a  

comprehensive  long-­‐term  home-­‐care  system.  Such  a  system  can  be  cost-­‐effec;ve  if  established  so  that  it  subs;tutes  for  more  expensive  forms  of  other  services  when  care  needs  

jus;fy  it.                                                                                    Neena  Chappell  Canada  Research  Chair  in  Social  Gerontology

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From Individual to Network Centric

Virtually all home care clients also rely on a spouse, adult child, friend or neighbour to provide practical assistance and emotional support. According to Nancy White at Canadian Institute for Health Information, having a friend or family member provide support in addition to paid home care, makes it possible for people to stay in their own homes.

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Acknowledging Dependency

..the support and assistance one individual requires of another where the one in need of care is ' inevitably dependent', …because they are young, too ill or impaired, or too frail to manage daily self-maintenance alone. Eva Kittay

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The Beauty of Dependency

The vulnerable people whom your committee is called to reflect about caring for, are often in a precarious state, mentally or physically or both. They are often in anguish. The old, those living with illness and perhaps near death, those in depression and with a sense of despair, those living with disabilities; these are all people living in a most fragile state. The danger in our culture of productivity and achievement is that we easily dismiss and ignore as unproductive the gifts and the beauty of our most vulnerable members, and we do so at our own peril, dehumanizing ourselves.

Jean Vanier - Letter to Parliamentary Committee on Palliative Care

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Caring Equals Citizenship

Citizenship is a way of making concrete our ethical commitment to care and to realize our obligations to aid our ‘fellow travelers.’ Mark Kingwell (The World We Want)

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Caring Equals Citizenship

Illness is the night side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. Susan Sontag

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2. Shifting Resources

…it's not good enough just to say: " Vital social goals should be put on hold because there's no money.”

Shift funds from institutions to home care - in recognition of family caregivers who are the backbone of Canada's health care system.

Sherri Torjman, Caledon

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Key Policy Question

What would it take to make it easier for people to take care of friends and families?

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Shifting Resources

Mantra #4. You can’t deliver 21st century care with a 1950s system.

Our health system was designed for the delivery of episodic acute care by physicians, principally in hospitals. The reality today is that most patients have multiple chronic conditions and they can be treated in the community.

We need to fundamentally re-shape the system to reflect their needs. That means an emphasis on primary care, on team-based care delivery and creating a continuum of care.

Our ultimate goal: A good life and a good death.

André Picard

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Shifting Resources

Home  Care  is  at  least  40%  cheaper  to  provide  than  insEtuEonal  care.  

Policies  that  support  the  needs  of  caregivers  are  important  for  several  reasons:    The  formal  care  system  could  never  replace  all  of  the  support  provided  informally;    many  caregivers  make  great  sacrifices  in  order  to  provide  the  care  that  they  do;    and  caregivers  express  a  desire  to  conEnue  in  this  role.  

Without  assistance,  however,  caregivers'  own  health  can  deteriorate,  forcing  care    recipients  to  rely  on  the  formal  healthcare  system  at  a  much  greater  cost.                                                                                                                            

                                                                     Neena  Chappell  Canada  Research  Chair  in  Social  Gerontology

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Thank you and Take Care

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                     Studies  show  people  heal  more  quickly,  get  sick  less  oOen,  and  use  health    

and  human  services  more  efficiently  when  they  have  a  supporEve  social  network.  

                                                                                                                                                           Tyze  Personal  Networks  

3. Supporting Passionate Amateurs

L’Arche; Representation Agreements; Roots of Empathy; Santropol Roulant; Tyze; Hospice; PLAN; La Leche League; MADD; RDSP; First Nations Caring Society; Slow Food Movement; JUMP; Vibrant Communities; Canadian Caregivers Association; Green St.;Ma Rue Vert; Taking It Global; Free The Children; Operation Nez Rouge; Ability Foundation; Inclusion Press; Judith Snow’s Laser Eagles Art Guild; Encyclopédie de L’Agora…

Kathy Kastner Donna Thomson Kathy Bromley

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4. Coming Together

At the heart of social innovation is a focus on working together. No one individual, network, organization, company, department or sector can resolve our stubborn social challenges on its own.

BC Advisory Council Social Innovation

We are bound together in a single garment of destiny. Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be. This is the interrelated structure of reality.

Martin Luther King

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Come Together

Since we share the same aspirations, ethics and challenges isn’t it time we came together? • First Nations, Métis, Innuit • Early Childhood Educators • Families • Caregivers • People with Disabilities • Mental Health Advocates • People with chronic illness • Teachers, unions, governments, opponents, allies, you, me

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Three Types of Innovation

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One: Disruptive Innovation Strengthen, support and scale local innovations in natural caring and belonging

Two: Receptive Innovation Increase receptive capacity of government, business and service providers to support natural care

Three: Bridging Innovation Create new intermediary (mediating) systems, technologies and organizations that ensure formal institutions and service providers can collaborate with natural care providers without overpowering them

Tyze Personal Networks

Links •  www.ccc-ccan.ca Canadian Caregiver Coalition a highly effective coalition pushing for family

caregiver reforms. •  BC Law Institute's and Canadian Centre for Elder Law's Project on Family Caregiving:

http://www.bcli.org/projects/family-caregiving •  Deloitte's annual Canadian Health Care survey:

https://www.deloitte.com/view/en_CA/ca/pressroom/ca-pressreleases-en/press-release/cdac709bf1325210VgnVCM100000ba42f00aRCRD.htm

•  www.irpp.org - Institute for Research on Public Policy - see Neena Chappell’s study Population Aging and the Evolving Care Needs of Older Canadians

•  www.fncaringsociety.com First Nations Child and Family Caring Society •  http://www.caledoninst.org/ anything by Sherri Torjman •  http://www.vifamily.ca/node/918 Vanier Institute of the Family •  www.participle.net A multi-disciplinary design social enterprise creating public services of the

future starting with the individual and their community. •  www.tyze.com Tyze a web based tool to assist in the creation of caring social networks.

•  www.appartenance-belonging.org/en/ Exploring all manifestations of belonging - 33 -

Thank you and Take Care

The capacity to care is the thing which gives life its deepest meaning and significance.

Pablo Casals

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