In my understanding, in the first round of the Open Care discussion both the terms “care” and “open” have been used referring to different meanings. This premise is my personal attempt to map these different uses.
- Care referred to a special kind of human interaction: someone (the care giver) gives attention to, and takes action for, someone else (the care receiver).
- Care referred to a set of artifacts: the products and services of the system which, in a given time and place, enables the care activities (i.e. the care interaction of the point 1).
- A. Open referred to the care system: a system is open when different actors have the possibility to play a role. This can happen when the whole activity package is opened and divided into parts with the possibility, for these different parts, to be distributed among different actors.
- B. Open referred to the information flow: a system is open when the information on which it is based are open. This can happen when these information are totally visible, accessible and transferable to other systems.
Considering the different meanings of “care” and “open”, in my view, there is a clear correlation between 1 and A, and between 2 and B:
A1 Open care refers to the final result. That is, it refers to the characteristics of the care system we intend to create: a care system where different actors (experts and non experts) are in condition to play a relevant role.
B2 Open care refers to the design/production process. That is, it refers to the characteristics of a co-design and co-production process: the process leading to the realization of the products and services on which an aimed care system is based.
For what I have understood until now the general motivation for the research (see the Open Care research introduction) seems to mainly refer to A1, where the consortium profiles and experiences are mostly linked to the B2.
In my view, at this stage of the Open Care research we should take a clear decision: do we want to deal with A1, with B2 or with both, A1+B2. If the choice is for A1+B2, we should clearly define when, where and how we will discuss of A1 and when, where and how of B2.
NB: The following Notes mainly refer to open care assuming the A1 meaning.
Since the beginning of human history, care has been exchanged (given and received) inside homogeneous, durable and relatively closed groups of individuals: families, clans, village communities, urban neighborhoods … In the past century, in parallel to that, care has been delivered also by dedicated institutions: hospital, kindergartens, elderly residences…
Today, for several reasons, the demand of care is growing and becoming more complex, while both the traditional and the modern offer of care are less and less capable to cope with it. In fact, in the present fluid, hyper individualized societies, families, village communities and urban neighborhoods are weakening (if not totally disappearing) and individuals, given their life structure, have less and less practical possibilities to take care of others (even when, in principle, they would do it).
In turn, care institutions, which were supposed to substitute the traditional community’s and individual’s care, have less and less economic resources (and often political will) to do it.
The gap between the growing demand and the shrinking offer of care is the basis of the present care crisis: a lack of care that is not only practical (the caring system do not succeed in coping with the care demand), but also psychological (the sense of loneliness deriving by the lack of sense of care throughout the whole society).
To overcome this crisis a brand new care systems has to be imagined and enhanced. To move in this direction, a first step is to better understand caring activities, considering their nature and diversity.
The practical/organizational side of care is particularly important because care is not only exchanging information and knowledge. Care asks also for proximity and action: doing something for each other, taking time and being committed.
Care activities. Care activities are quite diverse: they can be performed by whoever could be willing to do it (as to make the shopping for somebody who is momentary sick); they can require a lot of time, attention and assumption of responsibility (as to take care of the daily life necessities of somebody seriously ill); they can require timely actions by highly specialized experts (as surgery interventions in very specific moments). And so on.
In general terms, these differences are characterized by a set of main parameters, as:
- Time: duration, frequency, flexibility, …
- Space: virtual, hybrid, only physical, …
- Competences: normal everyday life socialization, specific diffuse knowledge, specialized expert knowledge, …
- Responsibility: very low; low, high, very high.
Different care actions should be attentively analyzed and mapped using this kind of parameters. Nevertheless, intuitively, we can already say that different care activities could be delivered by different actors in different modalities.
It comes that, to imagine a new care system, we should, first of all, recognize all the potential care givers, considering them as resources: effective care resource (when they are already active) and potential care resources (when they could be activated if some conditions would be given)
Care resources. In principle, everybody can care for someone else. He/she can do it in different forms (depending on his/her expertise and time availability), but all of them require attention. In turn, given that attention is a limited resource (each person has a limit in his/hers capability to give attention), this is true also for his/her capability to care. In other word, care (both the expert and non-expert one) is a diffuse but limited resource.
Presently, care systems are built on a mix of three main resources:
- Institutional care givers (based on professional actors)
- Third sector and charity organizations (based on both professional and non professional actors)
- Traditional care communities (as families, village communities, urban neighborhoods).
We know that, for different reasons, all of them are in difficulty to cope with the growing care demand. Therefore, the issue is to reshape the system in order to permit to some new potential resources to emerge and become effective resources.
Mainstream and contra trends. We have said that, in principle, everybody, depending on his/her time and expertise, could give some forms of care. But we can observe that today, in the contemporary societies, this care potential, clashes with the dominant culture and practice: a cultural attitude that, in the name of individual freedom and convenience, tends to assume a careless approach to everything and everyone (the throwaway society extended from things to human relationships). And: a mainstream practice of living that makes difficult to introduce care activities in the daily life (due to work constrains, to the evolution of families and to their being scattered in different places). Therefore, given the present structures of family and work, few people can commit to offering care, especially if this requires continuity, high responsibility and duration in time.
Nevertheless, several examples tell us that there still are several people who could and would dedicate some time/energy/attention to well defined caring activities - if and when an appropriate enabling system would permit them to do it in a easy and flexible way. This limited but diffuse caring availability is the potential resource that the socio-technical innovation should be capable to transform in an effective resource.
In other words, thanks to an appropriate socio-technical innovation, it should become possible to cultivate and harvest the limited individual caring resources of broader groups of subjects. That is, to catalyze and coordinate existing but not used care resources could be the key to overcome the care crisis of contemporary societies.
Hypothesis and vision
Hypothesis. If the close (social or institutional) organizations of the past cannot cope with the dimension and complexity of the present demand of care, they must be opened. That is: the care activities must be divided in smaller/lighter tasks, and allocated to a large number of actors, each one giving what he/she is capable/willing to give.
Vision. Open care is an ecosystem of care-related interactions, characterized by being distributed among a large number of individuals, groups and institutions, with different competence, responsibility and commitment: from the highly specialized actors and institutions, to family members, friends and neighbors with no specific knowledge and limited time availability.
Social preconditions and enabling systems. To be viable, open care requires two main social preconditions:
- The existence of a large number of other actors (relatives, friends, neighbors) willing to care for someone, even tough they have practical limits (in terms of time and resource availability) to the possibility of doing it.
- The existence of dedicated and specialized actors capable to intervene when their competence are (really) needed.
Given the previous social preconditions, the open care potentialities are made real thanks to the existence of a technological and organizational system capable to catalyze diffuse resources, coordinate them and give their action the needed continuity. More precisely, this enabling system should:
- match different demands with different offers (in terms of competence)
- give different care actions coherence and continuity (by the point of view of the care receiver)
- promote and support both relational and the highly effective ones (i.e. the most specialized, professional interventions).
- be organically part of a larger systems: the ecosystem of interactions that represents what today we can refer to as a local community.
Social innovation and open care
The open care viability is based on the existence of a whole stream of social (and socio-technical) innovation that is already moving in a similar direction. In fact, in the complexity of contemporary society we can find several promising cases (some of them are still social prototypes, someone else is already arrived to more mature stage). For instance:
- Circles of care: groups of citizen sharing a same problem (as: diabetes, allergies, obesity, … or simply the old age) who mutually support each other, with the supervision of a team of doctors and nurses (a well-known example is the Circle in UK: http://www.participle.net/ageing ).
- Network of care: coordinated networks of family members, friends and neighbors, who share and coordinate their efforts to care for a person with serious problems (a well-known example is Tyze in Canada http://tyze.com )
- Intergenerational cooperation: organizations that supports the encounter of young and elderly people mainly around the theme of collaborative living (a well-known example is Prendi a casa uno studente (Take a student at home), in Italy: http://www.meglio.milano.it/pratiche_studenti.htm )
- Collaborative inclusion: organizations of migrants and residents collaborating to produce both migrant’s inclusion and social values, for both the migrants and the whole community (an example is: Dine with us, in Belgium: http://dinewithus.strikingly.com )
Considering these very diverse examples, we can observe that they present three fundamental common characters: (1) some care activities are delivered by non professional actors; (2) the overall care burden is shared between different subjects; (3) specialized interventions are asked only when they are really needed.
These examples are interesting because they give us an idea on how open care components could work. Nevertheless, in my view, they are not yet the full representation of the open care vision. To better approximate it, two steps should be done:
- To rethink each one of these service ideas adopting the radically open approach that characterizes the Open Care research.
- To consider the whole socio-technical ecosystem, and to improve it in order to give all of them and a multiplicity of similar ones the possibility to emerge and flourish.