Vision Paper: Care – from crisis to transition

“We are not plagued by a care crisis limited to the health and social services sector, but we as a society are in the midst of a care transition.”

Why a care transition?

UPDATE: October 2024

What’s truly in crisis is not the healthcare system but the underlying “industrial model of care” itself. This model, which emerged in the mid-20th century, treats care as a standardised, transactional “good-like” service. The model was designed for a world with a young, generally healthy population, where illness and disability were seen as temporary deviations from the norm. This approach is increasingly ill-suited to our current reality.

THE CARE TRANSITION
(draft, comments welcome)

April 2024

Public debate in Finland suggests that care is in crisis, but in February this year, there were 5,608,218 caregivers in the country. Within Finland and beyond, all citizens are caregivers.

Lack of resources, rush and even neglect in care are familiar headlines. As familiar as the idea of a care crisis. However, “crisis” and a fixation on resourcing care services do not capture the full picture of why and how our need for care has changed and how we can meet that need.

This observation brought together 17 organisations in the summer of 2023, all of which work on care in diverse ways. These actors seemed to have one shared experience: a lack of alternatives. Saving the current service system is the only permissible goal for solving care problems. The way out of the crisis, the argument goes, is to return to normality by making the current service system smaller, more efficient or better-funded. Fixating on that option drowns out dialogue about the future of care.

Care — from crisis to transition

This publication by Demos Helsinki identifies that the care crisis signals the need for a care transition. But how can modern societies break free from the constraints of industrialised care? Societal contracts involving capital, state, and individuals have shaped industrial care models, proving insufficient in the new landscape of human vulnerability.

READ THE PUBLICATION HERE
(currently only available in Finnish)

Care cannot be confined to industrial frameworks. We identify four key dimensions of care that go beyond industrial scaffolding. Care activity is:

– Relational: It happens in relations
– Foundational: It is the foundation of every person and community
– Ethical: It always involves ethical considerations and power
– Asymmetrical: The capacities each of us has to care or be cared for vary

The informational and structural barriers hindering effective care delivery resemble other contemporary transitions, like sustainable or digital transitions. A care transition would have similar implications for individuals, including the emergence of new resources and challenges in caregiving.

Key findings

Typically, a publication like this would conclude with a series of recommendations. However, with any transition, society must choose its own course. Our role is to ensure that public dialogue is fruitful and that key stakeholders know the tools available to them.

This is why our “key findings” or “recommendations” for the care transition come in the form of 5 prompts:

– How do we increase the number of and strengthen the relationships in which responsibility for the health and well-being of others can grow?
– How to free up time for caregiving?
– How to reconcile the principle of an equal welfare state with wildly different individual resources for care?
– How are expanded responsibilities for care shared?
– How do we create structures and tools for care in the ‘social’ space between the service system and the individual?

If governments, service providers and citizens can answer those questions together, a socially backed vision for the future of care can arise, instigating one of the most crucial transitions of our times.

The care that we envision

If providing citizens with adequate care is a question of resources, then our resource book must be expanded. From care sectors being items on a budget sheet, a more realistic mapping of care-related resources could transform how we think about and provide care. A new logic of care is based on these foundational resources:

– Time
– Relationships
– Responsibilities/Accountabilities
– Individual strengths
– Collective tools and institutions

All of these are actually resources that care systems can make use of but that our current systems don’t account for.

Join us for an event on the care transition

We invite you (and those to whom you wish to extend the invitation) to participate in the discussion on the future of care and care on 17.4 at 14:30 at the Demos Helsinki office. The registration link is in the comments of the post.

This is not a traditional invitation to a launch event but an invitation to join a growing movement. The event will be in Finnish.

REGISTER HERE

Background and methodology

The project was initiated by Demos Helsinki, which held discussions on the future of care in spring 2023 with forty different organisations involved in care, health and wellbeing. The result was a fresh picture of the sector’s future, the consortium’s initial research questions and a multidisciplinary group of organisations and experts on the future and present of care. The questions and issues were addressed through literature reviews, concept analysis, scenario research and workshops. This is the final report of the project: a new vision for the future.

In the first phase of the project, a baseline survey was carried out, reviewing the latest national and international research and literature on caregiving in different disciplines. At the same time, an extensive context analysis and case study of new care practices in different sectors and countries was carried out. Using this baseline study, a shared snapshot of the current state of care and key tensions was created together with the project consortium. Work continued in two consortium workshops, the first of which generated alternative scenarios for the organisation of care. The second workshop explored what is desirable in the different scenarios and what societal change is needed to make them a reality. This gave direction to what a positive vision of the future of care could look like.

After the workshops, Demos Helsinki documented the results. The results were further developed through discussions.

Partners involved

We are thankful to our partners for seeing the value in this discussion and for taking this leap of faith with us:

– Tukena-säätiö ja Tukena Oy: Company and foundation producing services for people with an intellectual disability
– Autismisäätiö: Foundation supporting people with autism
– Espoon kaupunki: The city of Espoo
– Mielenterveysomaisten keskusjärjestö FinFami ry: Association supporting families of people with mental illness
– Helsingin diakonissalaitos: Non-profit providing services people at risk of social exclusion
– HDL Rinnekodit: Company producing health and social services, part of the Deaconess Foundation
– HelsinkiMissio: Social organisation offering services reducing loneliness in Finland
– Kela: Finnish social security service
– Kulttuuri ja taide ry: Central organization for associations in the Finnish arts and culture industry
– Kuntaliitto: Association advancing the interests of Finnish cities, municipalities and regions
– Omaishoitajaliitto ry: Advocacy and support association for carers
– Syöpäjärjestöt: Society of regional cancer societies and national patient organizations, promoting health and cancer prevention and maintaining the Finnish Cancer Registry
– Vaasan ammattikorkeakoulu: Vaasa University of Applied Sciences
– Vates-säätiö: Expert organization for the equal employment of people with disabilities, long-term illnesses and people with partial work capacity
– Museoliitto: Association providing services for Finnish museums and museum professionals
– Hyvinvointiala Hali ry: Association advancing the interests of private care providers

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