Time banks, where you pay with time and help with activities instead of money, could be the solution to combating social isolation and the need for care for the elderly in an aging world.
Caring for the elderly long-term is a challenge for everyone. Costs are high and the quality of service is, at best, unpredictable and often leaves something to be desired.
The US healthcare system is so complex that it is frustrating for experts. Even when people who need help with activities of daily living – such as dressing, preparing meals and bathing – receive the necessary care, they can still suffer from social isolation. And this can cause a relentless emotional exhaustion on caregiverswhether they are family members or trained professionals.
A group of researchers working with governments, businesses and nonprofit organizations seeks innovative solutions to pressing social problems, such as the aging population and the growing need for long-term care.
In their ongoing research, they are exploring a promising concept that could alleviate some of these burdens: time banka community-based mutual aid system that considers everyone’s time equally valuable.
A global demographic shift
By 2050, one in six people in the world will be over 65, an increase from one in 11 in 2019, according to United Nations projections. At the end of the 2070s, the number of elderly people may surpass that of children under 18 for the first time in human history.
Caring for a growing number of elderly people with a decreasing number of young people is expensive and complex. A Kaiser Family Foundation survey conducted in 2022 revealed that 90% of respondents could not afford the estimated $100,000 annual cost for nursing home care, and even the approximate $60,000 cost for home care was beyond the reach of most American families.
These high costs are compounded by the growing shortage of professional caregivers. The U.S. Bureau of Labor Statistics estimates that nearly 9 million new direct care professionals, such as nursing assistants, home caregivers and personal care aides, will be needed over the next decade to meet the needs of people who will need these services. A 2023 survey by the American Health Care Association revealed that 77% of nursing homes face staff shortages and 95% report difficulties in hiring.
Origins of the time bank
The time bank appeared in Japan in 1973through the work of Teruko Mizushima, a housewife turned social activist. It was later popularized in the United States by Edgar Cahn, a lawyer who dedicated his life to making society fairer.
The idea is simple: a hour of help equals one time creditregardless of the task or its market value.
Members accumulate time credits by helping others. There are countless options, but here are some examples: they can take someone to an appointment, prepare a meal or teach basic skills, such as knitting or changing a tire. After accumulating credits, participants can use them when they need support. So, if you dedicate a total of 60 hours to helping other people, you can redeem 60 hours at a future datein the form of someone who takes care of themselves.
The Mizushima Voluntary Labor Bank in Osaka, the world’s first time bank, used a complementary time-based currency known as “coin of love“, which members could save for later use or transfer to their family members.
Hour Exchange Portland, one of the oldest time banks in the US, is a system in which neighbors exchange services using time credits for almost three decades. It is among the hundreds of time banks operating in the country.
In tune with the realities of aging
The new research was developed to facilitate a comparative investigation of time banking practices in different countries and regions. In the last two years, there were interviews and focus groups with dozens of time bank participants and middle-aged and over-65 adults in the US and China.
The results suggest that time banks may be particularly useful for solve three problems associated with aging that conventional systems cannot address: financial accessibility to care, coverage of care and social isolation.
First, as the cost of paid care increases, time credits offer a new way to get basic assistance without spending more money. For many families, the ability to pay with their time instead of money can make caring for their loved ones more affordable.
Time banking also gives visibility into types of work that market-based systems routinely ignore or undervalue: emotional support, companionshiphelp with small daily routines and patient explanations about how new technologies work. These forms of care are rarely paid, but are essential to maintaining independence and dignity.
Perhaps even more important, time banking fosters connections because not limited to rewarding transactions. Instead, it assigns value to different types of human interactions.
Interviews indicated that services are exchanged through a wide range of activities: practice calligraphy with someoneteach Tai Chi, read aloud to someone with visual impairment or contact a neighbor to remind them to take their medication.
These exchanges are less about specialized skills and more about mutual support. They expand the care ecosystem and remind seniors that they remain essential members of their communities.
When seniors participate in time banks, feel seen, useful and integrated in the fabric of community life.
A way forward
Creating time banks that make it easier for families to manage elderly care responsibilities would require overcoming several challenges.
Some are inherent to time banks. For example, it is difficult to maintain high levels of participationsatisfy the diverse needs of the members of a time bank, reduce the risks of some members exploiting the system and bear administrative costs.
Other challenges are more specific to the care of the elderly. For example, it may not be feasible to maintain reciprocity among members, as those who are fragile tend to receive services from the time bank and cannot easily reciprocate.
But by analyzing the pros and cons of various models, the research team hopes to develop a time banking model tailored to elderly care.
