What if the value of shopping for a sick neighbor, checking in on an isolated elder, or joining a neighborhood watch group could be “deposited” and “withdrawn” when citizens needed help? Edgar Cahn offers a way to combine monetary and service credits so that informal social care networks can grow and flourish across the country.
The New Idea
Edgar has developed a way to restore mutual care as a standard feature of the communities in which we live. He has created dynamic, self-sustaining social networks that promote trust, reciprocity, and citizen engagement. Edgar’s idea was inspired by earlier success with a model called Time Banking, which he developed in 1980 as a tax-exempt medium of exchange, earned by one person helping another. Programs based on this concept have since proliferated, but the model lacks financial sustainability. Edgar’s new idea, CareBanks™, is a social enterprise which provides an economic engine of support for community-based change agents and their constituents. Its mission is to rebuild the networks of caring and trust that hold communities together. CareBanks’ core values include: (1) Assets—every human being has something to contribute (2) Redefining work—some work is beyond price (3) Reciprocity—helping works better when the giver and recipient of assistance have equal standing (4) Social networks—communities are stronger than individuals (5) Respect—all voices must be heeded. With elder care a first priority, Edgar is transforming his successful concept of “banking” civic engagement to a citizen-based insurance program.
In this new type of insurance (or assurance) program, members pay dual monthly premiums in cash and service credits that ensure that they are covered when qualifying events occur (e.g., a hospital stay, caregiver illness, loss of loved ones, or recuperation from illness). In addition, CareBanks generates civic engagement, shifting from a deficit-based approach of service delivery to an asset-based one in which clients are “co-producers” in creating a reliable system of support for themselves and for their communities. With a focus on serving and engaging older adults, CareBanks needs and values those individuals who have been sidelined by age, health, or financial circumstances. Even the most isolated and vulnerable members can contribute, help others, receive help with dignity, and participate in building a strong, resilient community.
Time Banking (TBUSA) has spread worldwide, through and beyond the organization Edgar founded. He launched CareBanks under the aegis of TBUSA, maintaining the concept of promoting reciprocal volunteer efforts, but adding the capacity to assure that members will receive services when needed. Also, Edgar has designed a full-time paid position for a “client leader” who is responsible for recruiting, managing, and sustaining the program.
In our increasingly busy, technological-reliant culture, people are experiencing a deficit of close relationships and community connectedness. Older generations in particular are losing their sense of purpose without personal networks and without ways to use their decades of experience and knowledge. This will become more critical for our aging populations, as they are healthier, better educated and more skilled than any generation in history. The challenge of how best to harness this resource of human energy and skill is on our doorstep. As Baby Boomers enter their retirement years, the U.S. Census Bureau projects that 72 million Americans (almost one out of five) will be 65 years or older, and of these, more than 7 million will be over the age of 85. The 85-to-100+ cohort, which will be the fastest growing segment of the U.S. population, will most likely to need daily assistance. By 2020, 12 million older adults will require some type of routine care, and our social services systems are likely to be overwhelmed by this “age Tsunami.”
Society has compelling reasons for helping older adults age in place while staying actively involved in their communities. Studies show a strong association between social engagement and positive health outcomes among older adults, even for those at-risk of developing dementia, a primary determinant for extensive long-term care. Older people who get the support they need to stay in their own homes can significantly delay or avoid nursing home placement. This maintains their quality of life and relieves the pressure on state and federal Medicaid budgets. However, no system is in place to enable seniors to remain in their homes and neighborhoods. Most seniors will eventually need help with daily tasks like shopping, preparing meals, bill paying, transportation, and even bathing and dressing. Many will need only occasional help to remain independent, but those with chronic needs will most likely be forced to leave their homes. And while these issues affect all socioeconomic classes, the need is greatest among the poor.
The traditional system of elder care—one that relies on the family with government funding as a backstop—is breaking down and ultimately insufficient. The demographically driven surge in need for elder care is paralleled by an equal drop in the availability of younger friends and family members to help. In 1990, there were eleven potential caregivers for each person needing help. By 2050, the ratio will be four to one. In the U.S. today, families provide 80 percent of elderly care. Although this care is unpaid, the cost to families and society is valued at $275B a year. Caring for a relative or friend not only requires time and energy, but a financial commitment as well. Many caregivers pay for essential goods and services without reimbursement. These expenses are not tax deductible unless the older person is a legal dependent. And, although Congress passed the National Family Caregivers Act, the companion tax credit has not been enacted. Some states offer caregivers financial support, but most do not. Over 60 percent of family caregivers have jobs and more than 40 percent also care for children. The large number of single parent families makes elder care even more difficult. These dual, often conflicting responsibilities affect caregivers’ attendance at work, stress levels, career prospects, and financial status.
Citizen sector initiatives, large and small, tend to start out with high energy and momentum, but have difficulty sustaining leadership and resources over time. These organizations carry the lion’s share of social service delivery and provide vehicles for grassroots advocacy. However, they generally lack an economically viable way to ensure their survival. The citizen sector must continually find and support a new generation of client leaders, but most potential leaders have to choose between making a reasonable living and devoting full-time to organizing community action or pursuing social justice. Edgar saw that this effectively excludes the leadership of low-income people, especially elders.
The CareBanks program offers a powerful tool for meeting a range of needs that government benefits and private insurance will not cover and that families are increasingly unable to address. It will help meet the growing need for informal care that allows older adults to live independently and contribute to their communities. In its simplest form, a TimeBank allows its members to earn one Time Dollar for every hour they spend helping others. They can use their Time Dollars to purchase assistance—exchanging an hour of assistance provided for an hour received. Because people earn more service credits than they can use for mutual care, the surplus is “banked” and used for community projects such as energy audits or tutoring. The CareBanks “assurance model” takes the service exchange approach a critical step forward, with important new strategies (e.g., premiums of cash and service) to assure members that they’ll receive help when needed, and to build the capacity to support a broad network of financially sustainable local sites. As with insurance, CareBanks’ viability is based on pooled risk.
CareBanks can provide specific help when it’s needed. For those who lack the safety net extended families provide, CareBanks will be a reliable source of short and long-term care. Instead of a matriarch or maven ensuring that everyone who needs care receives it, the coordinator, who typically works at home, schedules events and manages the deposits, withdrawals and delivery of services to CareBanks’ members. Members with specific skills will be recruited and asked to commit to providing a particular kind of service on a regular basis. Earned revenue will also allow the purchase of services if no members are available to provide them. For example, blocks of member hours can be “sold” to a home health agency to create a reserve fund to purchase services and defray operating costs.
CareBanks provides an essential system to supplement government and family support. People of all ages and all income levels can participate. At a modest cost, individuals, families or local businesses can join a program linking them to a large, caring community. CareBanks offers a unique opportunity for reciprocity, making no distinction between clients and caregivers. The program is structured so that it is not only possible, but expected and desirable for the elderly to participate. A strong but lean national office supports local adoption of the program, and provides a foundation for a self-sustaining national system that will one day engage millions of older adults.
The CareBanks approach opens a way for citizens to devote their full time to civic leadership and earn a living. In these self-sufficient economic enterprises, “client leaders” are compensated for weaving communities together. A paid community-based leader provides the “glue” and the staying power for a large neighborhood volunteer corps without a costly, cumbersome organizational framework. Because there is a paid staff person, each local CareBanks is eligible for VISTA volunteers and similar resources—particularly the rising numbers of senior volunteers. The coordinators earn their living as client leaders, and create a simple, low-cost infrastructure to sustain civic engagement. With an average monthly premium of $15, some members pay assurance premiums that combine money and time (service hours). Every household will pay at least 4 Time Dollars, and some would pay 8 per month, or 16 per month. The premiums of 300 members provide the coordinator an annual income of $54,600.
Funding strategies include member premiums and monthly licensing fees by local CareBanks ($150 per month for 26 to 150 members to $500 per month for over a thousand members). CareBanks also offers an attractive value proposition to corporate employee assistance programs. Because they are self-reliant, CareBanks are likely to attract government and other institutional support. The National Family Care Givers Act—expected to be renewed indefinitely—makes the state government a source of funding. (The State of Utah is a partner in the first pilot.) Each local CareBanks is locally funded; these range from a single site program with an annual budget of less than $24,000, to a ten-site program with a $95,000 budget. Led by Edgar, the national office has a small but talented staff and a modest budget. A multi-site tracking system will generate cost-effectiveness and impact data.
At least six CareBanks pilot sites are being established, geographically concentrated to facilitate assistance from the national office. A coalition of citizen organizations in Salt Lake City sponsored the first pilot, and a large congregation in Washington, D.C. was engaged for a second test site. Local hosts/sponsors of these social venture franchises include senior housing facilities, community-based organizations, long-term care insurers, HMOs, faith-based organizations, and retirement communities. Local partners have connections with seniors and community organizations; a commitment to cover staffing, occupancy, materials, and indirect expenses for three years; and the ability to hire, supervise, and house staff. The goal is a network with hundreds of local CareBanks affiliates.
Edgar has been driven by a sense of injustice all his life. His parents were highly involved in civic life, and he was raised to believe that all people were equal; that race didn’t matter. Educated at Swarthmore and then Yale Law School, Edgar and his wife co-created the National Legal Services Program and pioneered clinical legal education as co-founders and co-deans of the Antioch School of Law (now the David A. Clarke School of Law). It was the first U.S. law school in which women comprised more than half of the students, and it continues that tradition of diversity today.
A heart attack in 1980 left Edgar even more determined to set things in motion that could create a more just world. While in intensive care and recovery, he saw that the courts were getting hostile to civil rights, poverty efforts were being strangled, and the women’s movement was becoming bureaucratic. Edgar decided to build on “what’s right with people.” This led him to found TimeBanks, and now CareBanks.
Among his many mentors, Edgar cites his first employer, Robert Kennedy, whom he served as special counsel and speechwriter, and a therapist, Alyce Gullattee, who helped him regain his sense of self after his wife Jean died. But his parents were his most powerful role models. His father, a legal philosopher, taught him that we have an innate capacity to recognize injustice and a responsibility to respond to intolerable disparities. Ironically, Edgar is thankful for his father’s failure to fully value his mother’s abilities and efforts in the home because that spurred the “feminist economics” aspects of his programs (i.e., rejecting market price as the exclusive measure of value). His mother’s caregiving, neighboring, volunteering and civic labor influenced his goal to quantify the value of others like her who constitute an “underground economy” on which society relies.
Edgar’s colleagues say that he rallies people around his ideas and is enormously charismatic. His intellect and writing sparks new ideas and approaches, and his oratory stirs crowds and generates enthusiasm. But most of all Edgar moves people from his heart. He makes each person feel that their problem is important and that he has all the time in the world for them. Edgar is flexible and creative, always integrating and making changes as needed. Because of his broad vision, the service exchange concept is now applied widely (e.g., for foster families, prisoner re-entry, and youth courts Edgar created in which jurors are former juvenile offenders). A distinguished emeritus professor at the University of the District of Columbia David A. Clarke School of Law, Edgar teaches a course on systems change to first-year students. He is the author of several books, including, No More Throw Away People: The Co-Production Imperative.