Greater numbers of people in society need care. However, receiving care disrupts identity, changing the sense of self to being cared ‘for’, shifting the balance where a person may no longer feel independent, but has certain dependencies in their everyday life. These may lead to significant impacts on maintaining day to day life routines and activities. Many of these examples represent transactional care, where a person receives care (in the form of a care package) from another person or service based on their assessed needs, set out in contractual terms in relation to the length and nature of care specified. The person assumes the role of the ‘cared for’ in this transactional interaction. Design in the context of care, is concerned with systems and technologies, but also with social interactions and experiences.

In this position paper we propose that many forms of care can, and should be implicit with greater effort to ‘normalise’ care by supporting and instilling care values of empathy, compassion, and dignity; what we term the ‘subtleties of care’. There is a key role for design in developing asset-based care (Garven et al., 2016) which supports and responds to the aspirations and capabilities of people to enable eudaimonic wellbeing and prevent the assumption of the ‘cared for’, dependent role. The creation of asset-based care experiences can also promote a sense of identity that enhances self worth, personal growth and control, shifting care from a transactional model of providing and receiving, to a model which values the contribution of the person, self care, wider circles of care (including families and professionals) and the role of the community.

We acknowledge the need to make care explicit at a systems level, rebalancing the workload to foreground care and reduce bureaucratic data collection (Cottam, 2011), often driven by the need to manage risk. However, at a relational level, between the person and their care giver, this reprioritisation should allow care to be implicit and embedded in all social interactions. Whilst there is a need for designers to span both these domains, we propose that greater emphasis should be placed on understanding where people place value within care interactions and creating the conditions to foreground these moments. Framing the approach around this core objective, designers can ask the right questions and make more pragmatic decisions, and most importantly, appropriate methods to design ‘with’, rather than ‘for’ people (French and Teal, 2016).

In order to develop these ideas we will draw from examples of design research carried out in a number of care contexts and reflect on the role of creative, participatory and visual methods, and the mindset of the designer in these settings. Our work spans formal and informal care in community and acute settings, to design service delivery, technology, and systems. Within one project example staff delivering care have expressed the need for less obtrusive technology: e.g. using innovative technology and interaction design to reduce time spent inputting or viewing information to increase eye-contact. This theme cuts across a number of different contexts of health and care, including information systems and records, and video conferencing technology to deliver remote care. Just as the technology needs to fade into the background to allow for more natural and relational interactions between the person and their care worker, care needs to be embedded and implicit in conversations centred around the capabilities and aspirations of the person. In another example, we demonstrate the role of relational care through volunteering and the impact of this experience on a volunteer’s own sense of wellbeing. In setting out these examples, we will discuss the relationship between mindset and skill, and re-examine the role of design in making care processes unobtrusive and illuminating the value of relational care.