Finding the Money to Provide Home Care to the Elderly

Did you know that Japan has found an ingenious way to “create” money that can be used to care for the elderly?  Bernard Lietaer, author of Access to Human Wealth: Money beyond Greed and Scarcity (Access Books, 2003) describes the system in this interview with Ravi Dykema, publisher and editor of Nexus, a leading Holistic journal.

Lietaer begins with the basics, by explaining what money is: “I define money, or currency, as an agreement within a community to use something as a medium of exchange. It’s therefore not a thing, it’s only an agreement – like a marriage, like a business deal…And most of the time, it’s done unconsciously. Nobody’s polled about whether you want to use dollars. We’re living in this money world like fish in water, taking it completely for granted.”

Lietaer, who co-designed and implemented the convergence mechanism to the single European currency system (the Euro), and served as president of the Electronic Payment System in his native Belgium, doesn’t take currencies for granted. He knows that a dollar is simply a piece of paper (which is no longer backed by gold).  It has value because we have agreed that it has value.

But today, he points out, new currencies are being created: “there are
many new agreements being made within communities as to the kind of
medium of exchange they are willing to accept.” For example, “in
Britain, you can use frequent flier miles as currency. It’s not a
universal currency, it’s not legal tender, but you can go to the
supermarket and buy stuff. And in the United States, it’s just a
question of time before privately issued currencies will be used to
make purchases. Even Alan Greenspan, the [former] governor of the
Federal Reserve and the official guardian of the conventional money
system, says, ‘We will see a return of private currencies in the 21st
century.’”

Frequently, Lietaer notes, countries design a new currency with a social purpose in mind. This brings us to Japan: “there are about 300 or 400 private currency
systems in Japan to pay for any care for the elderly that isn’t covered
by the national health insurance,” he explains. “They are called
‘fureai kippu’ (caring relationship tickets).

“Here’s how they work: let’s say that on my street lives an elderly
gentleman who is handicapped and cannot go shopping for himself. I do
the shopping for him. I help him with food preparation. I help him with
the ritual bath, which is very important in Japan.

“For this help, I get credits. I put those credits in a savings
account, and when I’m sick, I can have other people provide such
services for me. Or I can electronically send my credits to my mother,
who lives on the other side of the country, and somebody takes care of
her.”

No matter what service is provided, one hour of service equals one credit.

This system “makes it possible for hundreds of thousands of [elderly]
people to stay in their homes much longer than they otherwise could,”
Lietaer observes. “Otherwise, you’d have to put most of these people
into a home for seniors, which costs an arm and a leg to society, and
they’re unhappy there. So nobody’s winning. In contrast, Japan has
created a currency for elderly care.

“In the United States, Florida is the only state that has the same
density of elderly people as Japan does—18 percent of the population is
more than 65 years old. But Florida is a model for our collective
future. Colorado will be there in 2020. Germany will be there in 2006,
France in 2008, Britain in 2012…If you put all of these elderly in
homes for seniors, you’d go bankrupt. Japan has been looking for
another way, and has found it by introducing a monetary innovation.”

In the U.S., currencies based on hours of service are called “time
dollars.” As this Time Banking website explains, a record of
accumulated “Time Dollars” is kept in a computerized “Time Bank,” and
Time Banking is now well established in the US. “Programs range widely,
from the MORE programs in East St Louis which focuses on health and
training and has 12,000 members who exchange 100,000 hours a year, to
small street projects involving a dozen residents.

“In New York, Mashi Blech has been running the Member to Member Time
Dollar Program for sixteen years. This is funded by an HMO and offers
older residents a catalogue of health related products and activities
in exchange for time credits.” 


The website
goes on to lay out the rules of accumulating and using time
dollars:

1.    Participants list the services they can offer and those that they need
2.    All agree to both give and receive services
3.    Everyone is interviewed and provides references
4.    Every hour giving help earns the giver one credit called a time credit
5.    Participants ‘buy’ the services and support they need with their time credits: every hour received is        one time credit
6.    The time broker co-ordinator matches up the giver and receiver
7.    Every transaction is recorded on a computer using a software package called Timekeeper
8.    Participants receive a regular time bank statement
9.    One hour is one credit regardless of the skills one offers
10.   Participants can donate credits to other participants or the ‘time bank pool’
11.   Everyone is seen as special with a contribution to make

What is almost magical about the concept is that, as Lietaer points
out, “For those people who are willing to give some of their time, the
money manifests automatically.
” In that sense, the system creates money.

“It doesn’t quite work that way with dollars, does it?” he asks.  “One
of the two of us has to get dollars by competing for them somewhere
outside of our community.”

“Time dollars” by contrast “are helping in a lot of communities where
conventional money is scarce: in ghettos, retirement communities, high
unemployment zones, student communities.” These are places where people
are likely to have more time than money. Rather than competing in a
competitive market where dollars are exchanged, they share services in
a co-operative market where they help each other.

“There are 31 states in America that are paying employees to start such
time dollar systems, because it solves social problems, says Lietaer.
“There are some operating in Chicago, fairly big ones in Florida. For
example, in Chicago, there are entire neighborhoods that used time
dollar systems to create a neighborhood watch system that got rid of
drugs and gangs. It’s working, it doesn’t cost anything to the
taxpayer, it doesn’t create a huge bureaucracy, and it encourages the
solution of the local problems by and with the very people who know
most about them.”

Lietaer explains that the time dollar system was invented by Edgar
Cahn, the author of No More Throw-Away People(Essential Works Ltd,
2000). Cahn claims that “if you can’t compete in the dollar economy,
you’re thrown away.” He shows how a time dollars system provides a
solution to this process, because it operates in parallel with the
conventional competitive economy, and it creates an environment where
everybody can contribute.” 

Time dollars can help to solve social problems without taxation or
large governmental bureaucracies. All you need is a community. Japan’s
model is certainly worth keeping in mind as we devise ways to provide
the home health care services that the elderly need.

5 thoughts on “Finding the Money to Provide Home Care to the Elderly

  1. Maggie,
    This concept is certainly appealing. I’m not sure I understand, however, how it differs from conventional volunteer organizations. For example, my father never learned to drive. When he needed to get to appointments with his doctor in his later years and could no longer easily walk to the bus stop (in the suburbs), volunteers from a local organization would sometimes drive him. Otherwise, he would have to take a taxi at considerable expense. They would also take people grocery shopping. A colleague of mine volunteers for a NYC based charity that delivers meals to home bound patients with AIDS. There are probably a lot of similar organizations.
    It is probably a lot easier to find people who can provide rides, maybe do some light housekeeping or help with meal preparation than it might be to assist with ADL’s like bathing, dressing, and eating. There is also presumably no assurance that those who accumulate time credits will be able to redeem them for the specific type of help they might need in the future. The time bank is still a good concept but I’m not sure how many people can be kept out of an institutional setting unless their needs are quite minor or if they have a family member who can provide extensive care in the home, albeit at considerable personal sacrifice.

  2. Barry–
    It differs from conventional volunteer organizations in that the volunteers are being paid by the person who receives the service.
    Many elderly people say that they don’t like asking others for favors. But if they feel that they are part of a community where they can contribute as well as receive, they feel much better about it–
    and community ties are strengthened.
    In Ithaca New York, thousands of people barter services with the “Ithaca dollar”–a time dollar. Merchants, plumbers, etc accept Ithaca dollars for goods and services (usually, for say 20% of their total revenues) which allows people who have time, but not money, to purchase these goods and services.
    In return, they might do some painting, help with gardening, cook some food for a party, grocery shop for your elderly relative, etc. It’s a community with a lot of students (Cornell is located there) as well as a lot of elderly people and low-income people, so it works out very well.
    In terms of home care, many elderly people who are able to dress and bathe still need help with grocery shoppping, prepartion of food,house-cleaning, yard clean-up, etc.
    Also, they’re just plain lonely, and if they’re housebound in a dirty house that they are not able to clean, watching weeds grow in their garden, they’re likely to become depressed–and physically sicker.
    And this is an ideal way to provide those services.

  3. In Bernard Lietaer’s earlier book ‘Future of Money’ he described four ‘icebergs’ converging on the present time, one of which is the ‘Age Wave’ in richer countries.
    ‘Community currencies’ really are an idea whose time has come. 25 years of experiments on every continent have brought us various models including ‘time dollars’ or ‘time banks’, Ithaca HOURS, LETS, Berkshares etc. Each one is designed to solve particular social or economic problems, in tandem with money. They make money go further and allow people to use their assets of skills, ideas and the instinct to care to create mutual rather than one way relationships.
    Volunteering service is a wonderful thing and will remain so. What community currencies do is draw others in to service by offering the incentive of help with their own problems and needs. Volunteers rewarded with credits may always choose
    to give their credits to others.
    As we master the problems of design, governance and management of these systems we will see them play an increasingly important role in society.

  4. John —
    Welcome to the blog.
    I certainly hope you’re right. It seems like a particularly good idea for seniors who often have more time to help each other. And I would imagine that these mutual relationships lead to friendships.

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