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Reflection by Edgar Cahn

This story documents what TimeBanking can do to address the social determinants of health. But how do we get that knowledge used?

According to the Congressional Budget Office, informal care represents 55% of the care that enables older residents to remain in community. The CBO values that at $252 billion dollars. And that estimate is way too low.  The AARP estimates the informal care is 80% of the care seniors receive to remain at home. And the AARP values that care at $450 billion dollars.

Each and every day for the next 17 years, 10,000 baby boomers are passing 65. And boomers have higher rates of hypertension, high cholesterol, diabetes and obesity. The average cost of just a semi-private room in a nursing home is $6,844 per month. Seniors and their families dread institutional care. They try to remain at home. That’s why systems of informal care are so critical.

Since we know what actually works to enable elderly persons to avoid institutionalization, why are we not requiring Medicare, Medicaid, and State Plans on Aging to provide for an expansion of informal care? How do we extend the health professions’ scope of their duty to provide an expanded version of minimally competent care? In one health center in England, a physician actually prescribes TimeBanking. He includes earning and spending Time Credits in the regimen he has prescribed for patients affected by depression, obesity, and other conditions.

If we formally classify social isolation as a recognized “high risk factor,” might physicians follow that example? Might that designation provide an incentive for health care systems to invest in TimeBanking? ArchCare, the medical care system operated by the Arch Diocese of New York operates a TimeBank. The nurses and social workers in that system make the referrals. Over 3,000 members in their TimeBank have generated over 58,000 hours of mutual help and support.

That’s what the Silver Tsunami might bring — both to health care and to all our communities.