By: Rayna Preston
Today we wanted to share our last blog post in our Aging in Place prototyping series. While we hope this prototype’s journey may continue in its many possible forms, the Lab’s involvement in this chapter of the journey has come to an end. NS GovLab has always been an incubator of ideas and potential solutions, however, our team does not run programs or implement full scale initiatives. That said, prototyping with the community and this work has been an important part of our work. It has generated considerable learnings and a number of potential next steps, and we wanted to share some of that story. We are curious to see where the prototype and its learnings may go next.
We left off in our last AIP prototyping post by sharing about the creation of AIP 2.0 and the testing process. Since then, our team has spent time in deep reflection and engaging in sensemaking processes that allowed us to understand the wisdom and feedback offered by the seniors, elders and service providers who so graciously shared their time with us. There were many things that folks shared, resulting in a set of learnings that can be used to improve the website tool but also, deeper and broader learnings related to:
- technology, digital equity and inclusion;
- aging-in-place as a concept, and;
- system-wide challenges such as the intersections between ageism and racism.
In this blog, we wanted to share a snapshot of some of the things we learned. For a full list of the learnings and to read a copy of the prototyping report please visit: https://issuu.com/nsgovlab/docs/aip_prototype_final_report_no_recommendations_1_
Key Technology Related Learnings
There is an universal need for technology and digital skills to remain relevant and engaged as an older adult in the NS voluntary sector
Many of the seniors our team tested with are very active and engaged community members. A few were retired and working in their second or third careers; many were active in supporting community through the voluntary sector. A key theme that came through their stories was both the need for and daily use of technology to support their efforts and how little formal training or IT support they have. Most expressed feeling overwhelmed by technology and the skills needed, and talked about how the amount of “computer work”, although already increasing before COVID, was amplified by the need to be connecting, ‘zooming’, and meeting virtually. They also outlined the importance of technology in reducing risk of COVID-19 but also to reduce social isolation in their age demographic. It was clear to staff that those who tested AIP 2.0 are managing and getting by using the technology they have but, many may not be using their technology, devices and software optimally or to its fullest potential despite their openness to learning.
Nova Scotians seniors have a lack of truly affordable high-speed internet options.
Access to affordable high-speed internet continues to be a challenge for older Nova Scotians living on a fixed income in both urban and rural areas of the Province. The physical availability of service for those living in rural communities is also a challenge for some. Monthly service costs depending on the level of service and number of Internet Service Providers (ISPs) in a local market can range in price from about $60 — $150 per month.
Most of the folks who tested AIP 2.0 indicated they had internet service in their home while a few received subsidized service through community-based organizations in the short-term. Almost all commented on the high but unavoidable cost of internet while also recognizing it has become an essential service — no different from the need for a home or cell phone, heating source, or food. The team also heard from some of those who tested AIP 2.0, about the poor quality of internet services in rural areas, slow speeds and limited bandwidth at peak times which impacts video connections, and poor mobile data coverage for those using smartphones.
Key Aging-in-Place and System Related Learnings
Aging-in-Place as a concept does not resonate well in Nova Scotia’s Black communities.
During testing, the Lab began each conversation by asking users what “Aging-in-Place” meant to them. In many cases folks were unsure what the concept meant at face value. A couple felt the notion — as traditionally defined — is focused too narrowly on the negative aspects of growing older — such as limited mobility and failing physical health — without accounting for the positives that come with growing older like wisdom gained, ability to be a role model and the capacity to support community, family and others. A few of the prototype testers also indicated that the language of “Aging-in-Place” was alienating for them; they wondered if it was being used to remind them of their lot in life and perhaps to convey the sense that they should “stay in their place” or that they should “know their place” in society and not deviate from it.
Given the historical connotations that notions like “stay in your place” have had and continue to have in Black and Indigenous communities, this was an important and surprising learning. If this tool is to be culturally appropriate, safe and relevant for African Nova Scotian users in particular, the name of the tool and the language used to describe “Aging-in-Place” may need to be reframed to reduce alienation and align the intent of the website with the perceptions and needs of the community.
Lack of culturally competent community-based care options
While testing, staff heard consistent stories about the lack of culturally competent community-based care and support for an aging population. For example, when ANS seniors living in rural parts of Nova Scotia reach the point where their own homes become too much to care for or where they may be unable to care for their own personal needs, there are no culturally competent care options for them to remain close to their communities. Home care services are generally provided by service providers from outside of their cultural community, those working in care homes are generally not from the community, and there are no long-term care options that keep seniors living in close proximity to their historic Black communities.
AIP Prototype Specific Learnings
AIP 2.0 can help connect some but not all seniors and caregivers to aging-in-place resources.
Those who tested felt that AIP 2.0 may represent a part of a communications strategy for informing citizens of what types of supports and resources exists, but that on its own, as designed, it could never meet all of the varied needs of users that exist. They indicated AIP 2.0 was an improved way to provide information about resources using an online channel for those already thinking about planning for AIP. They felt it would be useful to someone who was already trying to locate relevant local resources online — for example, someone who was engaged in preliminary information seeking around what might be available in certain locations for certain groups of seniors as long as those users had some online skills.
They did not feel this web-based tool would serve parts of the population with lower literacy, those without internet, devices or technology skills, or those who may be in crisis and need immediate supports. Despite this, system testers still felt there was value in tools like this as a way to provide asynchronous information about relevant services and supports online. All of the system navigator users who tested were clear though; a tool like this can never replace the need for in-person or live human-to-human, phone based navigational support services.
Testers were quick to pick up on missing content and user testing quickly demonstrated where existing questions are overly complex and judgemental.
Users made a number of recommendations about where and how to enhance the existing content — such as including self-identification categories for Veterans or Francophones and providing the relevant resources at the end of the tool that are dedicated to serving these groups. One tester asked why the questions about whether one needs home care, personal, or nursing care were not included in the physical health domain. NS GovLab staff intended to include a standalone domain called Care in Community that would ask questions and provide information about Continuing Care programs, direct funding supports, and respite options. Unfortunately, that placeholder was overlooked during the website build. These are important supports that many Nova Scotians are seeking to help them stay in their homes longer; information about how to connect to these, access them and what the process is, are highly relevant and should be included in an AIP web-based tool.
Watching how seniors and their families navigated the question content also offered significant insights into the wording and concepts included in the prototype. In particular, questions related to certain health behaviors such as healthy eating, food security and substance use were confusing for most respondents. There were many instances where seniors had to read the question several times to understand what was being asked; in other instances it was clear that questions were perceived as being judgmental and invoked feelings and reactions of guilt/shame (e.g. “yeah yeah I know I am supposed to eat healthy and not smoke”; “Hum…. do I smoke … should I answer truthfully here …. I will if you promise you won’t tell my mother”). If the tool is intended to be about planning, reflection, and action, there is no place for language that is overly complex, judgmental or confusing.
What’s Next?
The GovLab team is deeply thankful for the generosity of community members who graciously offered their stories, life experiences and opinions in helping us test this prototype. We encourage folks to read the report and see how the learnings might be applied in their own work. We have also made the web development files for the tool available to anyone with an interest in standing the tool up to test it themselves, or adapting for their own use on GitHub: https://github.com/SonWUT/AgingInPlace.git
Have thoughts or questions about this journey or the learnings? Curious about how you might build on this idea and want to talk in more detail with the team about that. Leave us a note or send us an e-mail (NSGovLab@novascotia.ca).
