Long-term care for older people is challenging for everyone. The costs are high and the quality of care is unpredictable at best, often falling short.
The U.S. health care system is so hard to navigate that experts can find it aggravating. Even when people who need help with activities of daily living – a list that includes getting dressed, preparing meals and bathing – receive the care they need, they may still experience social isolation. And it can take a relentless emotional toll on caretakers, be they family members or trained professionals.
We are researchers of government, business and nonprofits. Together, we are seeking innovative solutions to pressing social problems such as the aging population and the growing need for long-term care.
In our ongoing research, we’re exploring a promising concept that could potentially ease some of these burdens: time banking, a community-based mutual aid system that treats everyone’s time as equally valuable.
A global demographic shift
By 2050, 1 in 6 people around the world will be over 65, up from 1 in 11 in 2019, the United Nations projects. By the late 2070s, older adults could outnumber children under 18 for the first time in human history.
Caring for a growing number of older people with a shrinking number of younger people is expensive and complicated. A 2022 Kaiser Family Foundation survey found that 90% of respondents could not afford the estimated US$100,000 annual cost of nursing home care, and even the roughly $60,000 cost of in-home assistance was beyond the reach for most U.S. families.
These high costs are compounded by a growing shortage of professional caregivers. The U.S. Bureau of Labor Statistics estimates that nearly 9 million new direct-care workers, such as nursing assistants, home health aides and personal care aides, will be needed in the next decade to care for the people who will need their services.
Yet a 2023 survey by the American Health Care Association found that 77% of nursing homes face staffing shortages, and 95% report difficulty hiring.
kei_gokei/iStock via Getty Images Plus
Time banking origins
Time banking emerged in Japan in 1973 through the work of Teruko Mizushima, a housewife who became a social activist. It was later popularized in the United States by Edgar Cahn, a lawyer who dedicated his life to making society more fair.
The idea is simple: One hour of help equals one time credit, regardless of the task or its market value.
Members earn time credits by assisting others. The options are endless, but here are some examples: They can drive someone to an appointment, prepare a meal or teach basic skills, such as how to knit or change a tire. After they’ve earned credits, participants can spend them when they need support themselves. So, if you dedicated a total of 60 hours helping others, you could then redeem 60 hours at a future date in the form of someone caring for you.
Mizushima’s Volunteer Labor Bank in Osaka, the world’s first time bank, used a time-based complementary currency known as “love currency,” which members could save for later use or transfer to their relatives.
Hour Exchange Portland, one of the longest-running time banks in the U.S., is a system where neighbors have traded services using time credits for nearly three decades. It’s among hundreds of time banks operating in the country.
Resonating with the realities of aging
We have designed our research to facilitate a comparative investigation of time-banking practices across countries and regions. In the past two years, we have conducted interviews and convened focus groups with dozens of time bank participants and adults who were either middle-aged or over 65 in the U.S. and China.
Our findings suggest that time banking might be particularly helpful in solving three problems associated with aging that conventional systems fail to address: the affordability of care, the scope of care, and social isolation.
First, as the cost of paid care rises, time credits offer a new way to obtain basic assistance without spending more money. For many families, the ability to pay with their time instead of their money could make caring for their loved ones more affordable.
Time banking also brings visibility to types of labor that market-based systems routinely overlook or undercompensate: emotional support, companionship, help with small daily routines, and patient explanations for how new technologies work. These forms of care are rarely paid for, yet they are central to maintaining independence and dignity.
Perhaps more importantly, time banking fosters connections because it doesn’t simply reward transactions. Instead, it assigns value to many kinds of human interactions.
Our interviews indicated that services are exchanged through a wide range of activities: practicing calligraphy with someone else, teaching Tai Chi, reading aloud to someone who is visually impaired, or checking in with a neighbor to remind them to take their medication.
These exchanges are less about specialized skills and more about showing up for one another. They broaden the caregiving ecosystem and remind older adults that they remain essential members of their communities.
As we learned, when older adults engage in time banking, they feel seen, useful and woven into the fabric of community life.
Iuliia Burmistrova/Moment via Getty Images
A path forward
Creating time banks that can make it easier for families to handle their elder care responsibilities would require meeting numerous challenges.
Some are inherent in time banks. For example, it’s hard to sustain high levels of participation, meet the diverse needs of a time bank’s members, reduce the risks of some members exploiting the system, and pay for administrative costs.
Other challenges are more specific to elder care. For example, it might not be feasible to maintain reciprocity among members, as those who are frail tend to be on the receiving end of time-banked services and can’t easily give back.
But by analyzing the pros and cons of various designs, our research team hopes to develop a time-banking model tailored to elder care.