Citizens League
Report date
August 2018
What has been most instrumental to your progress?
1. We were able to engage people who had first hand knowledge of our target population--solos. Members of the Task Force and guest presenters came from different disciplines and so had interacted with solos in various ways. These diverse experiences brought a richness to the conversations. and a more complete understanding of a very complex issue. There were several eye opening moments. For example, we heard from an emergency room physician what it is really like trying to locate someone who can speak on behalf of an older adult who lacks capacity. Another speaker had worked both sides of the issue--first as a government manager responsible for delivering services to older adults and later as an advocate for an older adult who needed services. His comments allowed Task Force members to clearly see the disconnects that exist between what is needed and what is actually delivered. They also revealed that standard practices--however well intended--can often create barriers for solos.
The Task Force was able to gain support for the project because of the timeliness of the issue. Solos--as defined by the Task Force--are still largely invisible, especially those who still have the capacity to plan and make decisions for themselves. Ageist thinking and assumptions about the availability of family are embedded in many of the services available to older adults. Despite this lack of awareness, we had no difficulty in generating interest in our work. When we explained the purpose of the project, we saw light bulbs go off for people. Everyone seems to have a story about a solo they know. There was agreement that we need to craft solutions across the diverse solo population. the timing of this initiative is important because it is helping to build momentum and interest.
Key lessons learned
Health decision making by and for solos sounds like a fairly specific and narrow topic for a project. However, though the Task Force members understood the purpose of the project, it took four months before they fully grasped the challenges to be addressed. One reason for this was the lack of data to serve as a foundation. Equally important, there are many layers to this issue that had to be unpacked. The turning point came in January, after Task Force members had each completed personal interviews directly with solos. One member said the early discussions of laws and relevant data were helpful, but he didn't really 'get it' until he had a face-to-face conversation with a solo about health decisions. Even the geriatrician on the Task Force commented on how the personal interviews had allowed him to see solo older adults in a different light. Putting real faces on the issue made a huge difference. Perhaps the learning here is the value of bringing in the real world perspective as early in the Discovery process as possible.
The Executive Team struggled with how best to create a process that would be inclusive and reflect the needs and experiences of solos from diverse communities. Given the one-year time line for the project, it was difficult to create a balanced Task Force of people who could commit the required time. Our lack of success in getting the full 'representation' we sought, caused us to explore other ways to incorporate the diverse perspectives we sought. Out of that came the decision to implement the planned focus groups with members drawn from diverse cultures. We also decided to establish an Ad Hoc Review Committee composed of leaders from diverse communities. The committee's charge will be to review the draft report and recommendations and provide feedback on whether the ideas are reflective of all kinds of solos. The Ad Hoc group has not completed its work yet, but initial reaction to the approach has been very positive. We hope to incorporate their insights into the final report.
Reflections on inclusive, collaborative or resourceful problem-solving
We choose 'resourcefulness' because of the degree to which we were able to tap into personal and professional connections of the Executive Team and Task Force members. Such connections enabled us to locate solos for personal interviews and focus groups, along with knowledgeable professionals, including a physician, a volunteer, and a small business with expertise serving solos. Currently there is little valid and relevant data available around the issue of health decision making by and for solos. We had to think creatively about the various dimensions of the issue, and then hunt for resources. We were also resourceful in how we allocated the project budget. Originally we anticipated the need to bring in subject matter experts to inform the conversations. By the end of the Analysis phase, we re-framed our view of 'experts' to focus on community members who were knowledgeable about solos and solos themselves. These dollars will now be used to tap into their experiences and develop solutions and capacity.
Other key elements of Community Innovation
During the Analysis phase of the project, Task Force members were introduced to the concept of 'lateral thinking' formulated by Edward De Bono. This approach emphasizes the importance of challenging assumptions and looking at ideas from multiple perspectives. The lateral thinking concept helped Task Force members to create a new framework for solos--one very different from existing concepts about 'elder orphans' and 'unbefriended elders' being used to describe older adults without family. As this is beingdrafted, lateral thinking is helping to shape the recommendations and future strategies.
Understanding the problem
The project definitely reinforced the need for more thinking and work about solos and mentioned previously about timeliness. More importantly, the direct conversations with solos showed the common practice of treating solos as a specific demographic group can limit thinking and crafting of solutions around health decision making. Task Force members crafted a 'snapshot' of solos using the key idea of solo-ness as a descriptor and the notion of being 'functionally' solo. This is breakthrough thinking within the context of health decision making, which came about because of the big picture, interdisciplinary approach.
If you could do it all over again...
We'd spend less time and effort trying to create a perfectly balanced Task Force. The conversations directly with solos provided a wealth of information, and the Ad Hoc Review committee looks like an equally promising approach. We probably could have gotten started a month earlier and gained the benefit of input from more individuals.
One last thought
We have been heartened by the commitment and interest of the Task Force members. A year is a long time to devote to a study project and, overall, the participation has been excellent.