Anna Donaldson – The Reciprocal Care Model

Transcript

Ash de Neef: Anna thank you so much for joining us on the program.

Anna Donaldson: Thanks for having me.

Ash de Neef: Can we start, as we always do with a little bit about you and your story.

Anna Donaldson: Yeah, absolutely. So I’m the founder and CEO of a not for profit social enterprise in Melbourne called Lively. We train and employ young job seekers to help older people stay connected and live well. And we have a range of programs that bring that concept to life.
Which I can talk more about, but I guess a bit about myself. I’ve been working on Lively for about five years now. I fell into it after some volunteer experience as a life story writer for an aged care provider here in Melbourne during which time I was connected with an older lady who wanted her life story written.
And who I started visiting and continued to visit for a number of years and who was extremely isolated and alone at the end of her life. And it was a real eye-opener for me. Seeing what that experience looks like and after she passed away, it was like, I had my ears pricked to this issue of social isolation, amongst older people.
And all of a sudden I was hearing about it everywhere and realising how prevalent it is in the community and started to think about what could be done about it. And simultaneously had this growing concern around youth unemployment, knowing so many young people who couldn’t get work because they didn’t have experience.
And just going through that infuriating cycle of job applications, getting knocked back, wondering how you get experience when no one will give you a job. And so yeah, one day I had this random light bulb moment and thought that perhaps these two issues could be brought together to solve each other.
And that was the start of the journey. And here I am today.

Ash de Neef: Fantastic. And I do want to come back to Lively in a little bit, but can we go back to the start of the story there? And you’re working as a life story writer. What was the name of that?

Anna Donaldson: A life story writer is a volunteer for an aged care provider.

Ash de Neef: And how old were you when you were doing that?

Anna Donaldson: So I was in uni. I was 21 years old when I first started doing that.

Ash de Neef: And the woman that you visited, you visited over a number of years. What was the experience like in spending time with her?

Anna Donaldson: It was a pretty. I’m trying to think of a word to, to capture it…
It was a pretty incredible experience. Very rewarding, very challenging at the same time. When I met Patricia, she was being supported by an aged care provider in her own home. And she had expressed this wish to capture her life story and to actually write and publish a book about her life. And they were looking for a volunteer to do that, and they brought me in.
And when I first met Patricia all she wanted to do was just get this life down and publish a full-blown novel that she wanted to. She was really gun-ho she wanted to share with the world. She wanted everyone to know about this life that she’d lived and she had some of the most incredible stories.
But my favourite, which I always tell is a time that she just got drunk with a boy that she’d met and stowed away on a boat to Antarctica. And passed out and woke up halfway there and got sent back on another sort of cargo ship back to Melbourne.
And she was just this really vivacious, fierce kind of character, and I learnt a lot. And as a young person, hearing these experiences from her life and what that would look like was yeah, it was amazing and very eye-opening.
She never had family and just, through no fault of her own, she just found herself completely alone at the end of her life. And she was struggling with a lot of health issues and she couldn’t get out of the house at all. She was just stuck inside in this dark quiet house day in, day out with really nobody coming by, other than the care workers through her aged care provider and then me.
And as I got really intimately acquainted with her and her life and formed a friendship with her, it ended up being quite a lot of pressure on me as a young person in some respects to be that sole companion in her life.
And towards the end of her life, she moved into residential care and was visiting her in the facility. And the last time I saw her, I knew that she really was about to pass away. And I said my goodbyes and left and I called the facility a week later just to ask frankly, if she was still there and how she was going.
And I’ll never forget. The person who answered the phone, I asked them whether Patricia was still with them and she’d been there for months. And the response I got was. “Oh, who?” and they didn’t know who she was and they went off into “Oh, I’ll go find out.” And they came back five minutes later and said, “Oh yeah, she passed away a week ago.”
And that was it I remember getting off that phone call and just being left with the most…really indescribable feeling of just this. Yeah, this open-ended strange. Yeah. I don’t have words for it really. But just this feeling of having been witnessed to this incredible person and this incredible life that had just suddenly disappeared. And with no recognition or acknowledgement or celebration.
And it really, really stuck with me. And I just, I guess I had this sense of having just been witnessed to an experience and to a reality that just wasn’t okay. The more I came to discover how many other older people have that experience towards the end of their life.
The more I grew passionate about doing something about it more broadly. So that’s a long answer to your question that it was a big experience,

Ash de Neef: Yeah. That’s a great answer. It sounds like you got so much out of your relationship with Patricia so much at a very young age as well to change your perceptions of what it’s like to grow older. You know, when you’re 21, you have all these kind of misconceptions about older people.
So this is the genesis of Lively then?

Anna Donaldson: The experience that I had with Patricia, but also with other older people in my life, grandparents who I’d been very close to, I guess it had instilled in me a really strong sense of how much older people have to offer young people and how much young people gain from actually just spending time with older people and becoming privy to that wealth of experience and knowledge and the stories they carry.
So yeah, the idea that we could actually employ young people and provide meaningful jobs for young people in the process. It just felt like a no brainer and too much of a win-win for me not to pursue. So it started as a very broad and fuzzy idea of connecting young and older people in this way.
But yeah, that’s where that’s really where it all started.

Ash de Neef: Great. Can we touch on some of the programs that Lively runs? What sort of employment are you offering to young people?

Anna Donaldson: Yeah. So for the first few years that we were running, our primary program was a technology help program where we employed young people to help older people learn how to get online and use technology as a tool for connecting and communicating and pursuing their interests.
So whether that’s as simple as sending text messages or getting on to social media or learning how to do video calls, you name it just having the helpers there as a patient friend and companion to work them through it. And I had one older person who once described it to me as like having a grandchild who has more time and patience.
And I think that’s the perfect description of what that technology help program is all about. And then about a year ago we also went through a design process with young and older people that culminated in a full inter-generational home care service model. And we were approved as a provider by the department of health to offer a full home care service to older people who are on home care packages and requiring that in home support.
And then most recently this year, we’ve had a few other things pop up, obviously with COVID that just changed everything. And we ended up developing and delivering a remote support program to provide companionship and technology help virtually and remotely for older people during lockdown.
And also initiated an inter-generational gardening program where we could have helpers getting out in the garden with older people who love their gardens and want to stay involved, but just can’t do it all themselves anymore. And who would appreciate that sort of friendly companion and an extra pair of hands. Which thankfully we’ve been able to initiate because we can do a bit more outside now than we can inside at the moment as we come through the different levels of restrictions.
So yeah, there’s quite a range of different programs and services running now. And I guess our aspiration is to be continually responding to these new ideas and these new needs that pop up because we do so often hear from young and older people of new ways that they would like to support each other.
And one really lovely example is one of our existing helpers Justin, who’s a musician during lockdown. [He] recognised that he and other young musicians in the entertainment industry were obviously out of work while we were in lockdown. And that there was an opportunity to be hosting private zoom music performances for older people who might be isolated and learning and performing some of their favourite songs and using that as a point of connection.
And he sort of just started that initiative on his own steam and got that up and running. And so those are the sorts of things that we’re really keen to see springing up and coming to life.

Ash de Neef: When you’re talking about the home care program that you were developing, what kind of questions were you asking? What were you testing in the development process?

Anna Donaldson: Well, it was quite a long process. It was about a 12 month design process that we worked through and we started with this question of okay.
We know that the technology help service is working and that there’s a demand and an interest on both sides for that model. But we had this sense that there was so much more that young people could be helping older people with and vice versa. So whether that might be around the house or in the garden or getting out and about.
And we were first and foremost interested in actually what else did young and older people want to do together? And so we went through a process of interviews with a lot of young people and older people to understand their needs and how they might be able to fit alongside each other. And what we heard from that process was that, yeah, there was this sort of mutual interest in that broader range that I just described.
And I guess when we thought about that, we realised that a lot of those services were the services that are currently offered by home care providers and by the formal home care system. But when we were speaking to young and older people, I guess we realised that there was a lot about the way that those services currently offered that wasn’t ticking the box for them.
And there was an interest from young and older people in being able to engage with that sort of support in a different way. One of the key things that we heard was that for older people, they really didn’t like that idea of receiving care as this sort of transactional relationship where they were this passive recipient or this person that needed to be helped.
It gave them a sense – they felt like a burden. It felt like it undermined their sense of self and identity and and competence. And what they were really interested in was the idea of this relationship, where it was just that a relationship and an exchange where they would be seen and recognised for still having something to offer back to the person that was supporting them. And where the person coming to support was also actively interested in learning from and gaining new knowledge or skills or whatever it might be from the older people they they’re working with.
So I guess we set out to develop a home care service with that at its core. And with the core question of “how do we construct a service based on a fundamentally different care dynamic and relationship where it is about a two way partnership rather than a support worker and a recipient?” And around that, “how do we actually enable that relationship and that partnership to be as human and real and flexible as possible?” Rather than surrounding it with layers of bureaucracy and red tape that we heard from a lot of older people was very much a feature of their experience accessing formal care services through other more established providers.
And so we set out to figure out what that might look like. And we engaged a group of young and older people in a co-design trial, where we actually got them on board in working that out and nutting out the details of that from how they should set their schedules and figure out the time that they would see each other.
Through to how we should provide access to the budget and the live tracking of expenditure so that the older people and the young people could together make decisions about how they were going to use their care hours and what they were going to direct that towards. And there were lots of, sort of sub-questions for us that we worked through with young and older people to answer.
And I think what came out is a really unique approach to home care and a really different take on what home care actually means.

Ash de Neef: Sounds really great. And it all ties back to your experience with Patricia as well that it’s a give and take. Do you find that reciprocal arrangement can work in situations where an older person needs a higher level of care as well?

Anna Donaldson: An interesting thing is that, I guess when we first came into this service, we had an assumption that it would actually be best directed towards and best suited for older people who were perhaps a little bit earlier in their care journey and whose needs were not hugely complex. And that was the premise on which we said about launching the service at the start of this year.
But then interestingly, the first lady to engage in the service with was a beautiful lady named Lena who had advanced dementia and obviously very complex care needs. And for Lena, she’d been entirely resistant to accepting care services. Her family had been fighting a real uphill battle and were at their wit’s end. Because she just wouldn’t have anybody in her house to come and help her out.
And she really desperately needed it. But when she heard about Lively and when Lively was introduced to her, she really grabbed onto this idea that she would actually be supporting a young person. And giving a young person a go and giving a young person the opportunity to build skills and experience.
And for that reason and no other, she said “oh that’s fine. I’ll do it. I’ll give it a go so that I can help this young person.” And then the relationship that grew between that member and helper was just absolutely beautiful. And, you know, obviously with advancing dementia, that comes a time where it’s just not possible to support someone in the home anymore.
And Lena did need to move into residential care in the last couple of months, but there was, a year there where she and her helper enjoyed a really beautiful friendship and relationship and where the helper was able to really step up to the plate and meet those needs and deal with the complexity of the situation in a way that was was really exciting and inspiring to see.
So I would still say that in a lot of ways, our model is at its best with older people whose needs are not too complex. Because we do have to manage the need to support the young people’s development. And we can’t throw them into situations that are going to be beyond their experience and capacity to navigate.
But we’ve definitely seen the example that it can still work at the other end of the spectrum.

Ash de Neef: Fantastic. I imagine that in most of the assignments of a young person to an older person, most of those relationships that you’re facilitating, you’re trying to keep the same helper going to the same older person throughout?

Anna Donaldson: Yeah, exactly. And that’s really, again, one of the core differences in the way that this model works is that it is about matching the member with one or perhaps two core helpers who they then have a primary relationship with and rather than us sitting centrally and rostering our helpers and shuffling them around.
It’s actually up to the helpers in partnership with their members to set their own schedules and to really treat those relationships as their relationships that they carry through over time. Because that was one of the things that we heard really clearly from older people during the design process.
Was that far too often people’s experience is one of a revolving door of people coming through their home and unfamiliar faces and different support workers. And it’s such a vulnerable thing, having people in your home and there’s so much trust required. That experience was one that came through really strongly as being a need for change.

Ash de Neef: So one side of the coin of Lively’s work is also engaging the young people. What’s it been like to bring young individuals on board.

Anna Donaldson: It’s interesting. I often have people ask me that question and assume that we must have a real uphill battle getting young people into this work, because I think more broadly across the sector, that it’s a common story. That aged care providers are struggling to attract young workers and new professionals into this space.
In our experience, it’s been the opposite. We’ve had to maintain really long waiting lists of young people who are reaching out to us, seeking the opportunity to work with Lively. And we’ve actually had about 2000 applications for the 70 odd jobs that we’ve had available to date with really minimal recruitment or promotional effort on our part at all.
And we did a bit of research and exploration with young people around what was driving that and what it was that that was attracting young people to Lively. And really consistently the thing that we heard was that for young people who are just getting started in the world of work and who are looking for casual employment to just start building some skills and experience and testing the waters, the opportunity to do something that felt meaningful and like they were making a contribution and playing a valuable role in the community was so novel and so exciting relative to the other sort of range of things that are on offer to them at that point.
Which is basically retail and hospitality. And that was what they were jumping at.
And I have this real sense that the next generation of young people coming through is a really purpose driven generation. It’s young people who do want to make a difference and do want to feel like they’re using their time in good ways. And so for us, really centering the contribution that they would be making to older people has been a really effective way of inspiring young people to get involved in this space.
But then what very quickly keeps them involved is what they very quickly learned that they get from the older people through the process as well. Not only the reward of feeling like they’re helping them, but just the lovely relationships that they develop and that informal guidance and advice and the stories that they start to hear from the older people.
And the last time that we surveyed our helpers, about 92% of the helper said that they’re now much more likely to consider a career in the aged care space or related to the support of older people than before they got involved with Lively. The model that we’ve got that actually enables young people to dip their toe in and get some experience without having mentally committed to the idea of an aged care career is a really promising model for sparking that interest in young people in the sector.
And then potentially setting them on longer-term pathways of formal qualifications and an ongoing work in this field.

Ash de Neef: Yeah, that’s fantastic. And I have some friends who are similar age to me who work in more traditional aged care settings. And it’s been interesting to watch their journey – [it] has not always been a positive one and it’s not always been one in which they’ve felt, encouraged by the team around them to keep bringing enthusiasm.
So Lively might be a great environment in which to start that kind of work where there is an enthusiasm and a hope for the best.

Anna Donaldson: Yeah. And what was interesting actually, when we surveyed young people through this project was we asked them, would they be equally interested in the work if it was with another aged care provider?
And the vast majority said no. So we asked them why, and they said that it was because of the culture and the ethos and the vibe of Lively which is that yeah, as you said, energetic and optimistic. So yeah, I guess our internal theory of change is that we hope that by being that first step into this space for young people, we can get them really inspired, get them really motivated.
And hopefully that is able to sort of carry through over time rather than being something that is unfortunately, sometimes stands out quite early in their career once they do get out into the, into more traditional pockets of the aged care sector.

Ash de Neef: Fantastic. You’ve mentioned at the start [that] isolation was something you really wanted to tackle with this. How can you best serve the most isolated members of the community? Because these people are often not on the internet and very hard to actually reach out to.

Anna Donaldson: Look I would say it’s an ongoing process for us to figure out how to reach those who are most isolated, because as you’ve said, by virtue of their isolation, they are the hardest to reach.
We’ve probably had our most success in working with other community partners and we’ve taken a very sort of clear strategic approach so far of engaging with the local communities that we operate in. And forming really strong relationships with local council and other local service providers who are often, that little bit more closely connected to those who are at the fringe of the community.
And they’ve been able to refer people to our programs and that’s worked really well. But I still think that there’s more that we can do, particularly for those who aren’t connected to any form of services or to community networks. And we’re actually looking at another design project early in the new year to start yeah start working through that piece with a bit more attention.

Ash de Neef: So that’s trying to engage the community more. Can you give us any sort of insight into next year’s growth?

Anna Donaldson: So aside from the growth of the existing sort of programs and services that we’re offering, I think what’s front of mind for us is how we actually build really rich local networks in the particular local community areas that we’re looking to operate.
And for us, what we’re eager to be doing is connecting young people who are themselves local to a particular area with older people in that community. And then building out around that a really rich network of community support. And so what that looks like is where I think there’s a lot of opportunity for design in terms of the way that we interface with and work with other existing community organisations and resources and groups, but also the way that we reach out.
And, as a small example, I’m reminded of a couple of characters that I often see in my own local area, particularly this year when I’ve been around the area so much during lockdown. Particular faces and older people who are very often see sitting by themselves on a park bench or sitting out the front of a particular cafe when the cafes are open. And who I’d never seen speaking to anybody.
And I think that there are particularly local cafe owners, local supermarkets and GPS. There are people in the community who will see people as they go about their daily life. And we’re really interested in how we can start to think about activating that potential. And enabling individuals in their community to actually play that connector role and to reach out and engage somebody in that community of support. So it’s all in idea land at the moment but it’s something that we’re really excited to start exploring.

Ash de Neef: Yeah. That does sound really exciting. You can imagine a different – not a different world entirely, but a different kind of relationship that we have as a community, to all the members of it.
And I guess at the heart of it, there’s a belief that it can be better and we can be more inclusive beyond the scope of the work that you’re doing with Lively. Do you feel like, how do you think we can change those relationships as individuals or as a community?
What do you see as the kind of actions to get those balls rolling?

Anna Donaldson: That’s a tough question.
I think that it’s been a really interesting time this year particularly with our experience through COVID. Because I really do sense that it has given people this you know, shaken people out of just the busy-ness of their every day and given pause to reflect on, what matters and what’s important in life.
And I think, almost universally, one of the answers has been that people are what matters and it’s those connections and relationships that matter. And I think that there’s a lot of people who are questioning what to do with that going forward and how we actually take those new insights and that new level of care for our community and the connections around us and make and translate that into a more positive future for our community at a high level.
I think that it’s going to look, the answer is going to look different for every person. But I think that to me, it’s really small things. It’s, “what if we can be rather than feeling a little bit shy and awkward and uncomfortable and overthinking, reach out to that person who we see sitting by themselves in the park and just say hi?” And start up a conversation rather than walk past because you don’t know how to engage.
Or put up a little notice on your community notice board saying that you’re happy to go for a walk and a chat with somebody who might find themselves feeling a bit on their own. It could be such small things, but I think that if you start to imagine everybody doing just a tiny little thing like that you know, at some point in their week, the impact would be massive.
So there’s stuff that we can do at the political level, at the high level. But I also think that it’s just those really, really small grassroots actions that, that probably actually changed societies.

Ash de Neef: Yeah, absolutely. What I’m hearing is that you’re optimistic out of the pandemic as well, that this is, it’s changing the way that we think about people and the relationships.
And especially we’re both in Victoria having seen how a lot of residential care got locked down and people were unable to leave their rooms for a period of time. I think that’s, it’s getting out into the wider community. How much of an issue this isolation is amongst older adults. So I’m also optimistic that out of this, we can see some change. And hopefully with the work that Lively is doing the work that we’re all doing individually we can kind of turn this thing around.
Changing tack a little bit. What does leadership in the aged care industry look like for you?

Anna Donaldson: To pick up that point and what we were just talking about as far as optimism goes, I would like leadership in the aged care sector to be characterised by optimism and energy. Because I can’t tell you how many seminars and conferences I’ve sat through where I’ve come away at the end and felt that all I’ve heard from people who were there presenting, who are leaders in the industry is what’s so hard about this work.
“We’ve got this challenge to overcome and this challenge to overcome this barrier and this obstacle.” And there can be this sense of, “Oh, it’s all so impossible and we don’t have the funding and the community isn’t supportive enough and our politicians aren’t supportive enough.”
Because, and then that actually ripples out and I think that really affects the perception of this industry and it affects the willingness of smart, enthusiastic, motivated people to actually pursue a career in this space because they see other sectors as being far more innovative and dynamic and and exciting.
And I really think that what we need to see is leaders across the sector, actually just coming forward with optimism and excitement and enthusiasm about this work and the part that it plays in our community and the future of this sector. And I think that would take us a long way. I
I’m often concerned by the fact that sometimes when I go to conferences or events and present the single thing that people that I get the most feedback from people about is the fact that “Oh, you sound so hopeful and energetic about this!”
And the fact that surprises people really, or that that’s striking to people really bothers me. So yeah, I think leadership is actually, in this sector just needs to look like inspiring hope and a positive vision of the future and changing the perception that many people have about the industry through the process.

Ash de Neef: So where can people find out more about Lively

Anna Donaldson: You can go to our website, which is just www.Lively.org.au. All of our contact details are there. You’re also more than welcome to reach out to me directly for a chat. And I’m happy to share my email with. You and the listeners, which is [email protected].
And yeah, I really warmly welcome people to reach out and get in contact if they’re interested in getting involved or are interested in partnering and being part of some of the broader design pieces that I mentioned earlier, that we’re always interested in working on.

Ash de Neef: Awesome. Thank you so much for your time today, Anna.

Anna Donaldson: Thanks so much for having me on.