In 1994 American couple Paul and Lori Hogan started a business called ‘HomeInstead’. The business was based upon the experience of caring for the couple’s grandmother as she got older and became less independent. They realised very soon during the care they were giving that it was much better for an older person to stay in their own home rather than become institutionalised too soon. In such circumstances, with assistance from the outside in doing some of the things that become harder as one ages, it is possible to lead a relatively full, active and happy life. The ultimate result was that their grandmother lived a lot longer than expected, partly due to the support given to her, which still enabled her to class herself as independent.
Since that time, the HomeInstead model has become more widespread, through various standardised franchises across the world. What is innovative also about the model, is that it seeks to offer help to people at all levels, for all lengths of time and attaches as much importance to the social side of continuing life as the physical side. It is a viable alternative to early residential care, and, used as a preventative measure, can help keep people’s independence for longer, especially important as people are living longer than before, therefore the time of life this care could apply could be anything from the late 60s onwards – that’s up to four decades. The company even sought to solidify the notion of people acting as ‘CAREgivers’ by trademarking the role, signifying how it has become far more important than previously considered. One might argue that many families offer such support for free, but there are distinct advantages to all concerned for professionalising the role. Being able to pay for specific assistance, even once in a while, takes the pressure of other care-givers, freeing them up a little to live their lives. Similar models are now being adopted by other third sector and private organisations, who have recognised the benefits that a ‘pick your level of intervention’ approach has brought. Another advantage to the model is that is is payable by the hour, so people on limited budgets can combine it with other services or help from friends and relatives. This does mean, however, that those employed as ‘CAREgivers’ need to be flexible and not necessarily looking for full-time employment.
People can now hire a care-giver for all manner of activities, at all intensities and levels, even going to concert with them, companionship, making their meals, helping them get washed and dressed etc. What is inbuilt in many of these models is a level of social care that sadly has been absent from council-provided services which have been squeezed until they provide just the basics. The impact, however, of a mode of intervention like this is potentially huge in terms of health benefits, less worry for caring families and friends, reassurance of quality and less strain on residential homes. This type of service does contrast greatly with the basic service offered by most local councils. What is significant about it in terms of lifelong learning is that it seeks to provide some extra dimensional for people at a time when traditionally they would not have been engaged in activities.
One problem, however, with services such as this are that they have to be able to survive. That is not a criticism, but people’s time is valuable and it costs money to pay people by the hour to attend to other people. Consideration needs to be given to an infrastructure for quality control, recruitment, on-going support, training and monitoring. On a one-to-one basis such a service can only continue for a limited amount of time because most people don’t have endless resources, so targeted help plans which plan for assistance with specific things are effective, alongside an emphasis on well-being and friendship. This is where other activities are necessary, not only in order to enhance life, but to complement the targeted care given.
There are two aspects of this industry which I would like to point out in the context of what my research is about.
Firstly that being a care-giver could be perhaps an ideal occupation for many people who would class themselves as older adults. In an official capacity, getting paid a little bit of money to be able to attend the needs of another person can be a huge privilege, especially if one can show empathy and relate to the other person, perhaps because one is not too far away in age, but more importantly, because one has experience. It is going to make such a difference to that person’s life if they are able to achieve a balance in their life which enables them to continue albeit with some constraints. The hours of work need to be suited to the recipients, not the company, and the nature of the work requires certain skills, not least the ability to establish and to develop a fruitful relationship with the person being cared for. For most working in such an environment, money is not the main motivator.
Secondly, being able to offer complimentary activities within the lifelong learning field to engage, enthuse, motivate, and enable people to continue as social beings is going to help the whole societal system of keeping people healthy.
We have to therefore redesign our concept of society for older adults, so that services can do what they seek to do in a complimentary manner, and so they can also survive. We have to recognise that older people are not going to be able to pay continually for such things, instead, we must realise that other services are likely to be less drained because, overall, because of a combination of positive factors, older people are able to maintain a level of activity, independence and engagement with society for longer than previously imagined. I shall be discussing this with agencies and organisations as my research progresses, as it represents a fundamental shift in policy and a different way of justification to what we have become used to.
Finally, what is refreshing about HomeInstead, and I am sure other similar organisations, is that they genuinely seem to be concerned with the ethics of their practice, as opposed to being a faceless body running a string of institutions. If you sense a hint of directed bile in the last sentence, then please interpret is as being based upon the unsustainable philosophy of running every service independently as a business. Certain things need supporting and running as services because, without them, the cost would be far, far greater to us as a whole.