Improving access to culturally-connected home care
Type of work
Service design, design research
My additional roles
Project management and client communication, prototyping in Figma, data visualizations
Most Canadian seniors want to age-in-place, but depend on support to do so. In a one-size-fits-all system geared toward assisted living, it is a challenge for immigrant seniors and their families to find the culturally-appropriate home-based care they need.
Our team developed a service that matches seniors with community-based support workers who are equipped to address their intersecting care and cultural needs, as well as suggests group activities that can promote vital social connection.
The problem
COVID made it clear — new options are needed for how we support and care for seniors in Ontario
The Challenge brief asked us to delve into a critical local problem, and responded with a service concept that could enhance accessibility, challenge the ownership paradigm, and cultivate community.
The pandemic was a rude awakening about the state of senior care in Ontario. Care Homes and other live-in facilities make up the backbone of our system, but don't have the capacity or flexibility to provide adequate care for the diverse and growing senior population. Furthermore, most older adults would actually prefer grow old at home.
However, being able to age-in-place requires at-home support that can be hard to access, inconsistent, and costly. For seniors from diverse backgrounds, connecting with Personal Support Workers (PSWs) who can provide culturally-specific support is an added challenge.
Discovery
Our system isn't meeting the needs of the diverse and growing senior population
Seniors make up a growing percentage of the population, and in Ontario, over half are immigrants to Canada. Counter to the preferences of most seniors, public funding goes mainly to assisted living, of which only 16% are culturally specific.
The wide gaps in publicly-funded home care are filled by informal caregivers, such as family members, or by PSWs working for private agencies. These vital support workers have limited professional autonomy and many cite burn out as the reason for quitting, further exacerbating care worker shortages.
A visualization I developed to help communicate our findings.
Engaging stakeholders helped us understand challenges and desires related to aging, and intersections with culture
We conducted 6 semi-structured interviews, 40 surveys, and 6 cultural probes, diving deeper into the everyday experiences of key stakeholders. We heard from immigrant seniors about feelings of cultural disconnection, from family caregivers about the challenges of finding appropriate support, and from a geriatric specialist about the benefits of community-based care.
Examples of complete activities, designed by my colleagues Sade and Scott based on group ideation.
Key insights from research
With findings from primary research, we conducted thematic analysis to draw out insights. The following learnings directly impacted our final design.
Support that accommodates language needs and familiar food is crucial to the well-being of immigrant seniors, but a challenge to find.
Seniors want to remain independent but socially connected. Despite this, feeling isolated is a common experience for the elderly.
The city has many informal seniors’ communities, where high numbers of older adults live in a single neighbourhood or even building.
PSWs play a crucial role providing in-home support, but attrition is high because of low job satisfaction and high rates of burnout.
Definition
Exploring opportunities for intervention
Through generative questions and "what if" scenarios, we explored different aspects of the problem, and opportunities for intervention; below are examples from that process. In iterative steps, we converged on a single framing of the challenge.
How might we strengthen cultural practices as seeds for expanding seniors' community support networks?
What if there was a service that facilitated the sharing of home-cooked, ethnocultural meals between seniors and younger neighbours.
How could we tap into neighbourhood data to improve community and reach more seniors needing support?
What if data about informal seniors communities could be used to establish hubs for clustered support, enabling PSWs to act as both caregivers as well as community builders.
How could we centre the cultural capacities of PSWs to provide a more tailored care experience, in which workers feel more highly valued?
What if seniors and their families could access a list all the PSWs in the local area with the skills needs to provide culturally appropriate support.
How might we improve access to culturally-connected and community oriented support for diverse seniors living at home, enabling them thrive while aging in place?
Services are missing that support both cultural and community needs, while improving PSW autonomy
With the challenge clarified, we looked at a competitive landscape of existing service providers to hone in on opportunities for innovation.
Research of 6 local home care providers and PSW agencies showed there was a niche for a service that would prioritize both culturally-connected home care and promote community, but also give PSWs greater agency in their work. This process helped us establish design criteria.
A matrix breaking down how services meet different criteria for our core users.
Establishing design criteria
Must
Improve access to culturally appropriate, certified home care
Promote community for seniors
Avoid added risk to seniors’ safety
Be accessible for seniors to use
Enable PSWs to organize their own work
Should
Encourage communal support and activities
Promote seniors’ independence
Partner with existing community spaces and programming
Help PSWs cluster geographically proximate clients
Increase job satisfaction for PSWs
Could
Reduce burden felt by family
Alleviate strain in other parts of the care system
Bring down the cost of accessing home care
Improve data about seniors’ needs
The design
A home care service that emphasizes culturally-connected support, community engagement, and job quality
Through a process of iterative prototyping we developed Around the Block, a peer-to-peer service that connects seniors with PSWs and group activities. It simplifies the process of finding culturally appropriate at-home support, while simultaneously encouraging participation in shared programming to strengthen social networks and bring down the cost of care.
For PSWs, the service provides greater professional autonomy, offering more control over wages and scheduling to increase job satisfaction and improve workforce retention.
The service is built on a process of matching — we assess the needs of seniors, skills of PSWs, and available community programs, to suggest pairings. An accessible digital platform plays a key role in facilitating these connections.
We identified that opportunities for communal support, such sharing meals, could help address several of the pain points we had uncovered: a lack of social connection among seniors, the affordability of care, and excessive travel for PSWs. Small groups of seniors with similar needs or interests could be organized to receive support from the same PSW. This could help build community for seniors and improve efficiency for caregivers.
In addition to direct benefits for seniors and PSWs, the service could also have value for families, community centres, and government agencies.
Outcome
Our team was awarded first place in the competition, and as a result, got to take part in a 3 month residency with Philips Experience Design. We also receive further mentorship from IBM.
The Jury Statement
“This outstanding concept not only solves a very pressing problem of helping seniors find the support they need and connecting them to the people who can offer that support, but it takes into account the cultural background of both the elders and the workers to build connections. The team has dived into and understood the elderly’s local ecosystem —their needs, their children, the care workers, and the local community centres— and has created a solution for a global challenge which can be scaled. It is a very human and warm approach to connecting people with the help of technology.”
— The Service Design Challenge’s jury of industry leaders from: Philips, IBM, Ellen MacArthur Foundation, among others.
Reflections
Personal growth
This challenge not only presented a valuable mentorship opportunity, but also allowed me to exercise leadership skills. Managing and organizing the team underscored the value of delegating responsibility to meet deadlines, but also the importance of maintaining synchronization to ensure that learnings were shared across the entire team.
Something I'd do differently
I was surprised by the enthusiasm and willingness of individuals—including influential healthcare experts—to engage with us because we were a group of motivated students. We could have taken advantage of our unique position to seek input from additional experts, stakeholders, and collaborators, which could have enhanced our understanding and the overall strength of our project.
Next steps
If we had the chance to take the project further, it would be valuable to delve into a few key areas: ensuring the digital aspects of our service are truly accessible for seniors, mitigating risks of elder abuse, and crucially, conducting comprehensive user testing, ideally using role-play and iterative co-creation with seniors and PSWs to refine the service.